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NPI Code Detail

MEDICARE: MELISSA S SHIVELL-HERNANDEZ CADCII, CRC

MEDICARE: MELISSA S SHIVELL-HERNANDEZ CADCII, CRC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor01R15OR
2101YP2500XProfessional Counselor00093194IL

General Provider Information

NPI Number : 1083831143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA S SHIVELL-HERNANDEZ CADCII, CRC
Provider Business Mailing Address
First Line : 11515 NE 49TH ST
Second Line : MM101
City : VANCOUVER
State : WA
Zip : 98682-6144
Country : US
Telephone Number : 503-957-3418
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2916
Country : US
Telephone Number : 503-239-5738
Fax Number : 503-239-8429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 09/11/2025

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