Healthcare Provider Details

I. General information

NPI: 1316728215
Provider Name (Legal Business Name): MELISSA ROMEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 SE SUNNYBROOK BLVD STE 210
CLACKAMAS OR
97015-5767
US

IV. Provider business mailing address

2154 NE WEIDLER ST APT 5
PORTLAND OR
97232-1540
US

V. Phone/Fax

Practice location:
  • Phone: 971-265-9385
  • Fax:
Mailing address:
  • Phone: 708-269-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10191
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: