Healthcare Provider Details

I. General information

NPI: 1184533598
Provider Name (Legal Business Name): MERIDIAN PROFESSIONAL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22220 SALAMO RD # 662
WEST LINN OR
97068-7206
US

IV. Provider business mailing address

PO BOX 662
WEST LINN OR
97068-0662
US

V. Phone/Fax

Practice location:
  • Phone: 360-338-8286
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY ROBERTS
Title or Position: OWNER
Credential: LPC, LMHC
Phone: 360-338-8286