Provider Demographics
NPI:1700408580
Name:CHAMBERLIN, MELISSA (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 NW KINGS BLVD # 191
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3986
Mailing Address - Country:US
Mailing Address - Phone:541-257-8664
Mailing Address - Fax:
Practice Address - Street 1:230 SW 3RD ST STE 208A
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4651
Practice Address - Country:US
Practice Address - Phone:541-257-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health