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General NPI Number Information
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NPI Number | 1124310610
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Entity Type | Individual
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Provider Name | MELISSA ANNE YANG SUDP, LMFTA, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1011 E MAIN
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City | PUYALLUP
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State | WA
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Zip | 98372-6779
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Country | US
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Telephone | 815-715-5201
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Fax |
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Provider Business Mailing Address
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Address Line | 17125 KINNIKINNICK CT SE
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City | YELM
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State | WA
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Zip | 98597-9729
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Country | US
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Telephone | 815-712-5201
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Fax | 253-753-2115
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60277305
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG61304540
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61485988
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License Number State | WA
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