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General NPI Number Information
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NPI Number | 1760982953
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Entity Type | Individual
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Provider Name | RENEE MELTON MA, LPC, ATR
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Gender | Female
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1110 SE ALDER ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 971-368-2910
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 SE ALDER ST STE 301
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City | PORTLAND
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State | OR
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Zip | 97214-2400
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Country | US
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Telephone | 971-368-2910
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 12-248
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C4680
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License Number State | OR
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