MEDICARE: MELISSA HARSHMAN

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	T-14-072	OR

General Provider Information

NPI Number	:	1598200289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HARSHMAN

Provider Business Mailing Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5182
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 NE 82ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-5182
Country	:	US
Telephone Number	:	503-408-9585
Fax Number	:

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

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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Directions to “ MELISSA HARSHMAN ” Practice Location

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