Provider Demographics
NPI:1992830376
Name:BYRD, MELINDA (PSYD)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14523 WESTLAKE DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7700
Mailing Address - Country:US
Mailing Address - Phone:503-807-1103
Mailing Address - Fax:503-620-5369
Practice Address - Street 1:14523 WESTLAKE DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7700
Practice Address - Country:US
Practice Address - Phone:503-807-1103
Practice Address - Fax:503-620-5369
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3791103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181849Medicaid
OR181849Medicaid