Basic Information
| Provider Information | |||||||||
| NPI: | 1760982953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELTON | ||||||||
| FirstName: | RENEE | ||||||||
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| Credential: | MA, LPC, LCPC, ATR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9450 SW BARNES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032162811 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9450 SW BARNES RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032162025 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2018 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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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 | 101YP2500X | 180.008688 | IL | N | Behavioral Health & Social Service Providers | Counselor | Professional | 221700000X | 12-248 | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | 101YP2500X | C4680 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.