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General NPI Number Information
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NPI Number | 1588226765
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Entity Type | Individual
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Provider Name | MELISSA LYNN HARTLEY MS, NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1217 NE BURNSIDE RD BLDG C, SUITE 503E
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City | GRESHAM
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State | OR
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Zip | 97030-9703
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Country | US
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Telephone | 503-998-9733
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Fax |
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Provider Business Mailing Address
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Address Line | 342 SE KELLY AVE
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City | GRESHAM
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State | OR
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Zip | 97080-7738
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Country | US
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Telephone | 503-679-2689
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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