Healthcare Provider Details

I. General information

NPI: 1932503067
Provider Name (Legal Business Name): MELVIN ELSY LABELLE III M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 S ATLANTIC ST
SEATTLE WA
98144-3615
US

IV. Provider business mailing address

4310 NE 5TH ST APT B101
RENTON WA
98059-4725
US

V. Phone/Fax

Practice location:
  • Phone: 206-454-3947
  • Fax: 206-726-8564
Mailing address:
  • Phone: 206-454-3947
  • Fax: 206-726-8564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60501058
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: