MEDICARE: MELLISSA JOANNE SOL MSW,QMHP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1215951074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELLISSA JOANNE SOL MSW,QMHP

Provider Business Mailing Address
First Line	:	2415 SE 43RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1600
Country	:	US
Telephone Number	:	503-998-8224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 SE 43RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1600
Country	:	US
Telephone Number	:	503-998-8224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/16/2008

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