Basic Information
| Provider Information | |||||||||
| NPI: | 1083831143 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIVELL-HERNANDEZ | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CADCII, CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11515 NE 49TH ST | ||||||||
| Address2: | MM101 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986826144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039573418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 SE BELMONT ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972142916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032395738 | ||||||||
| FaxNumber: | 5032398429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 01R15 | OR | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 00093194 | IL | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.