MEDICARE: MELODY LARSEN LMFT, LCPC

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	106H00000X	Marriage & Family Therapist	BBH-LMFT-LIC-38685	MT
2	101YM0800X	Mental Health Counselor	BBH-LCPC-LIC-38841	MT

General Provider Information

NPI Number	:	1891109617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY LARSEN LMFT, LCPC

Provider Business Mailing Address
First Line	:	5206 NE 32ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-6914
Country	:	US
Telephone Number	:	605-641-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	5206 NE 32ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-6914
Country	:	US
Telephone Number	:	503-308-8216
Fax Number	:

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	03/06/2026

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