Healthcare Provider Details

I. General information

NPI: 1205646031
Provider Name (Legal Business Name): MELISSA CARBAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W MISSION AVE
SPOKANE WA
99201-2337
US

IV. Provider business mailing address

106 W MISSION AVE
SPOKANE WA
99201-2337
US

V. Phone/Fax

Practice location:
  • Phone: 509-473-4811
  • Fax:
Mailing address:
  • Phone: 509-473-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70040512
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: