MEDICARE: MELISSA BRADY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6501	OTHER	WA	EMPLOYEE ID NUMBER

General Provider Information

NPI Number	:	1770690513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BRADY

Provider Business Mailing Address
First Line	:	2527 112TH DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2527 112TH DR SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5152
Country	:	US
Telephone Number	:	425-220-4719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	12/06/2023

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Directions to “ MELISSA BRADY ” Practice Location

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