Provider Demographics
NPI:1942550538
Name:HARDER, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HARDER
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 1:2703 NE STANTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3538
Mailing Address - Country:US
Mailing Address - Phone:503-260-9153
Mailing Address - Fax:
Practice Address - Street 1:4605 NE FREMONT ST
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1707
Practice Address - Country:US
Practice Address - Phone:503-260-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health