=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114431913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA LYNN LAWSON MA CADC III
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2017
-----------------------------------------------------
Last Update Date | 12/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 NW MONROE AVE
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-4721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-766-2109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 557 NW MONROE AVE
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-4721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-766-2109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 17-R-42
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------