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General NPI Number Information
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NPI Number | 1851588263
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Entity Type | Individual
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Provider Name | MELISSA LARA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2007
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Last Update Date | 09/29/2007
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Provider Practice Location Address
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Address Line | 3000 MARKET ST NE STE 530
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City | SALEM
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State | OR
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Zip | 97301-1835
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Country | US
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Telephone | 503-390-5637
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Fax |
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Provider Business Mailing Address
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Address Line | 614 MARIA AVE W
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City | MONMOUTH
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State | OR
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Zip | 97361-1016
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Country | US
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Telephone | 503-586-4630
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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