Healthcare Provider Details

I. General information

NPI: 1003384348
Provider Name (Legal Business Name): MELISSA CHRISTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OREGON AVE STE 111
TACOMA WA
98409-7462
US

IV. Provider business mailing address

12228 SE 233RD ST
KENT WA
98031-3632
US

V. Phone/Fax

Practice location:
  • Phone: 206-774-9842
  • Fax:
Mailing address:
  • Phone: 206-774-9842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61574633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: