Provider Demographics
NPI:1073203725
Name:MELLER, BLAKE A
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:A
Last Name:MELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANIYAH
Other - Middle Name:LEXICON
Other - Last Name:KRAMER-MELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7759 SE 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-7921
Mailing Address - Country:US
Mailing Address - Phone:503-788-4500
Mailing Address - Fax:
Practice Address - Street 1:7759 SE 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7921
Practice Address - Country:US
Practice Address - Phone:503-788-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health