=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689720294
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA R WOHLHUETER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 12/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2260 CARILLON PT
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-7446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-828-0100
-----------------------------------------------------
Fax | 425-828-6839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 41ST AVE E #304
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98112-3284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-772-2294
-----------------------------------------------------
Fax | 425-828-6839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LH 60229730
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------