MEDICARE: MELISSA MASINI LPC, LMFT

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
1	101YP2500X	Professional Counselor	C3289	OR
2	106H00000X	Marriage & Family Therapist	T0987	OR

General Provider Information

NPI Number	:	1740479187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MASINI LPC, LMFT

Provider Business Mailing Address
First Line	:	1235 SE DIVISION ST
Second Line	:	STE. 204
City	:	PORTLAND
State	:	OR
Zip	:	97202-1099
Country	:	US
Telephone Number	:	503-704-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 SE DIVISION ST
Second Line	:	STE. 204
City	:	PORTLAND
State	:	OR
Zip	:	97202-1099
Country	:	US
Telephone Number	:	503-704-2016
Fax Number	:

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	01/27/2015

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