Healthcare Provider Details

I. General information

NPI: 1063177269
Provider Name (Legal Business Name): MELISSA A JONES CRM/PSS/QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA A CEDILLO CRM/PSS/QMHA-R

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 NW DIVISION ST
GRESHAM OR
97030-5523
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-2641
  • Fax: 503-231-1654
Mailing address:
  • Phone: 503-224-1044
  • Fax: 971-260-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTHW000105322
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R-7572
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21-CRM-470
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier500799872
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: