Provider Demographics
NPI:1619360989
Name:ALVAREZ, MELISA
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:ALVAREZ
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 1:1815 SW 16TH AVE
Mailing Address - Street 2:#303
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-8027
Mailing Address - Country:US
Mailing Address - Phone:949-204-6393
Mailing Address - Fax:
Practice Address - Street 1:1952 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1304
Practice Address - Country:US
Practice Address - Phone:503-597-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health