Basic Information
| Provider Information | |||||||||
| NPI: | 1558872770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMERS | ||||||||
| FirstName: | MELISSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 SW EASTWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970809477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609475893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 SW MADISON AVE # 118 | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973334798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415571892 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2017 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.