Healthcare Provider Details

I. General information

NPI: 1184173023
Provider Name (Legal Business Name): MELINDA BALE LMT, PY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 NE 76TH ST
VANCOUVER WA
98662-3721
US

IV. Provider business mailing address

9714 3RD AVE NE STE 103
SEATTLE WA
98115-2047
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-4912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY60131125
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: