Healthcare Provider Details

I. General information

NPI: 1306225503
Provider Name (Legal Business Name): MELISSA HERNDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA WURSTER

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 FENWICK CT N
KEIZER OR
97303-4327
US

IV. Provider business mailing address

6917 FENWICK CT N
KEIZER OR
97303
US

V. Phone/Fax

Practice location:
  • Phone: 775-443-0406
  • Fax:
Mailing address:
  • Phone: 503-390-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5253
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: