Healthcare Provider Details

I. General information

NPI: 1629509104
Provider Name (Legal Business Name): MELISSA YEARY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10883 SE MAIN ST STE 204
MILWAUKIE OR
97222-7641
US

IV. Provider business mailing address

10883 SE MAIN ST STE 204
MILWAUKIE OR
97222-7641
US

V. Phone/Fax

Practice location:
  • Phone: 503-451-3732
  • Fax:
Mailing address:
  • Phone: 503-451-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC4446
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: