Healthcare Provider Details

I. General information

NPI: 1578304655
Provider Name (Legal Business Name): MELISSA G MCAUGHTY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 W IDAHO AVE
ONTARIO OR
97914-2111
US

IV. Provider business mailing address

2095 SW 6TH AVE
ONTARIO OR
97914-3147
US

V. Phone/Fax

Practice location:
  • Phone: 801-920-0510
  • Fax:
Mailing address:
  • Phone: 801-920-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6871873
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: