Healthcare Provider Details

I. General information

NPI: 1669822573
Provider Name (Legal Business Name): AMANDA RAY MELIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E HAYES ST STE 205
NEWBERG OR
97132-1390
US

IV. Provider business mailing address

2855 E HAYES ST STE 205
NEWBERG OR
97132-1390
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-2894
  • Fax:
Mailing address:
  • Phone: 503-567-2894
  • Fax: 503-554-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: