Provider Demographics
NPI:1740593383
Name:PLATT, MELISSA GAYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GAYLE
Last Name:PLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 SE DIVISION ST STE 218
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-2567
Mailing Address - Country:US
Mailing Address - Phone:617-412-8705
Mailing Address - Fax:
Practice Address - Street 1:1125 SE DIVISION ST STE 218
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2567
Practice Address - Country:US
Practice Address - Phone:617-412-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-25
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2535103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical