Provider Demographics
NPI:1588226765
Name:HARTLEY, MELISSA LYNN (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 SE KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7738
Mailing Address - Country:US
Mailing Address - Phone:503-679-2689
Mailing Address - Fax:
Practice Address - Street 1:1217 NE BURNSIDE RD
Practice Address - Street 2:BLDG C, SUITE 503E
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-9703
Practice Address - Country:US
Practice Address - Phone:503-998-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORR5851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health