Provider Demographics
NPI:1346586799
Name:TODD, MELISSA (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 WILLAMETTE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4683
Mailing Address - Country:US
Mailing Address - Phone:513-541-6336
Mailing Address - Fax:541-600-3320
Practice Address - Street 1:1849 WILLAMETTE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4683
Practice Address - Country:US
Practice Address - Phone:513-541-6336
Practice Address - Fax:541-600-3320
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-12
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2442103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling