Provider Demographics
NPI:1407287766
Name:GOODMAN, MELISSA CLAIRE
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CLAIRE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NE 8TH ST
Mailing Address - Street 2:P. O. BOX 1579
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4909
Mailing Address - Country:US
Mailing Address - Phone:503-474-2024
Mailing Address - Fax:503-474-4454
Practice Address - Street 1:105 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4909
Practice Address - Country:US
Practice Address - Phone:503-474-2024
Practice Address - Fax:503-474-4454
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13-03-22101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)