Healthcare Provider Details

I. General information

NPI: 1407569874
Provider Name (Legal Business Name): MELISSA LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 12/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HILLIARD LN
EUGENE OR
97404-3222
US

IV. Provider business mailing address

84 W CEDAR AVE
DENVER CO
80223-1830
US

V. Phone/Fax

Practice location:
  • Phone: 541-780-6836
  • Fax:
Mailing address:
  • Phone: 720-298-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: