Healthcare Provider Details

I. General information

NPI: 1336690544
Provider Name (Legal Business Name): MELISA DEMEYER MS, PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2016
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 NE NORTON AVE STE 3
BEND OR
97701-4386
US

IV. Provider business mailing address

336 NE NORTON AVE STE 3
BEND OR
97701-4386
US

V. Phone/Fax

Practice location:
  • Phone: 541-287-4513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-6040
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC5689
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: