Healthcare Provider Details

I. General information

NPI: 1760982953
Provider Name (Legal Business Name): RENEE MELTON MA, LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 SE ALDER ST STE 301
PORTLAND OR
97214-2400
US

IV. Provider business mailing address

1110 SE ALDER ST STE 301
PORTLAND OR
97214-2400
US

V. Phone/Fax

Practice location:
  • Phone: 971-368-2910
  • Fax:
Mailing address:
  • Phone: 971-368-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number12-248
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4680
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: