MEDICARE: COUNSELING WITH MELISSA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1073252151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING WITH MELISSA

Provider Business Mailing Address
First Line	:	6917 FENWICK CT N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-4327
Country	:	US
Telephone Number	:	775-443-0406
Fax Number	:

Provider Business Practice Location Address
First Line	:	6917 FENWICK CT N
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-4327
Country	:	US
Telephone Number	:	775-443-0406
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA WURSTER
Credential	:	LPC
Telephone Number	:	775-443-0406

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	05/27/2022

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Directions to “COUNSELING WITH MELISSA ” Practice Location

Language	Start Address	Practice Location

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