Healthcare Provider Details

I. General information

NPI: 1326730946
Provider Name (Legal Business Name): MELINA ELISE VAN FLEET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 SW JUNEAU ST
SEATTLE WA
98136-1621
US

IV. Provider business mailing address

4219 SW JUNEAU ST
SEATTLE WA
98136-1621
US

V. Phone/Fax

Practice location:
  • Phone: 206-207-5395
  • Fax:
Mailing address:
  • Phone: 206-207-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: