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General NPI Number Information
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NPI Number | 1891109617
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Entity Type | Individual
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Provider Name | MELODY LARSEN LMFT, LCPC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 5206 NE 32ND AVE
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City | PORTLAND
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State | OR
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Zip | 97211-6914
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Country | US
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Telephone | 503-308-8216
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Fax |
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Provider Business Mailing Address
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Address Line | 5206 NE 32ND AVE
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City | PORTLAND
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State | OR
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Zip | 97211-6914
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Country | US
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Telephone | 605-641-7618
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | BBH-LMFT-LIC-38685
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | BBH-LCPC-LIC-38841
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License Number State | MT
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