Healthcare Provider Details

I. General information

NPI: 1184928483
Provider Name (Legal Business Name): MELISSA CHAVON YADEN EAMP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 LAWRENCE ST STE 102
PORT TOWNSEND WA
98368-6554
US

IV. Provider business mailing address

PO BOX 693
CHIMACUM WA
98325-0693
US

V. Phone/Fax

Practice location:
  • Phone: 360-434-0670
  • Fax:
Mailing address:
  • Phone: 360-434-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60198889
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60185523
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: