Healthcare Provider Details

I. General information

NPI: 1588729578
Provider Name (Legal Business Name): MELINDA R. GELDER PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N LAUREL ST STE 107
PORT ANGELES WA
98362-2637
US

IV. Provider business mailing address

650 QUAIL RUN RD
PORT ANGELES WA
98362-8298
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-6454
  • Fax:
Mailing address:
  • Phone: 360-582-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF00002335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: