Provider Demographics
NPI:1417590282
Name:UTZ, MELISSA K (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:UTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20510 SW ROY ROGERS RD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9320
Mailing Address - Country:US
Mailing Address - Phone:503-765-6361
Mailing Address - Fax:
Practice Address - Street 1:20510 SW ROY ROGERS RD UNIT 302
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9320
Practice Address - Country:US
Practice Address - Phone:503-765-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional