Individual provider Active NPI

Melissa Coleen Mejias, LICSW

  • Clinical Social Worker
  • Bothell, WA
National Provider Identifier
1215091673
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW 60096205 Issued in WA
Practice address
19125 N Creek Pkwy Ste 120
Bothell, WA 98011-8000
Phone
(253) 409-3044
Fax
(360) 443-7570
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LW 60096205 WA Primary

Addresses

Primary practice location

19125 N Creek Pkwy Ste 120
Bothell, WA 98011-8000

Mailing address

19125 N Creek Pkwy Ste 120
Bothell, WA 98011-8000
Phone (253) 409-3044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LW 60096205WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Roots Mental Health Clinical Current Accepting new patients

Locations

19125 North Creek Pkwy
Ste 120
Bothell, WA 98011
Phone (425) 588-0480

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1215091673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19125 N CREEK PKWY STE 120",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118000",
            "telephone_number": "253-409-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19125 N CREEK PKWY STE 120",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980118000",
            "telephone_number": "253-409-3044",
            "fax_number": "360-443-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEJIAS",
        "first_name": "MELISSA",
        "middle_name": "COLEEN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW 60096205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bothell, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.