Provider Demographics
NPI:1275507923
Name:HART, MELISSA G (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 SW GALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-1065
Mailing Address - Country:US
Mailing Address - Phone:541-994-2458
Mailing Address - Fax:
Practice Address - Street 1:4909 S COAST HWY
Practice Address - Street 2:
Practice Address - City:SOUTH BEACH
Practice Address - State:OR
Practice Address - Zip Code:97366-9648
Practice Address - Country:US
Practice Address - Phone:541-265-5960
Practice Address - Fax:541-574-6252
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL17391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical