Basic Information
| Provider Information | |||||||||
| NPI: | 1275507923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6815 SW GALLEY AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973671065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419942458 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4909 S COAST HWY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEACH | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973669648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412655960 | ||||||||
| FaxNumber: | 5415746252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| 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 | 1041C0700X | L1739 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.