Provider Demographics
NPI:1013718410
Name:MELESE, EDEN G
Entity type:Individual
Prefix:
First Name:EDEN
Middle Name:G
Last Name:MELESE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16707 SE HAIG ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-1421
Mailing Address - Country:US
Mailing Address - Phone:503-278-6398
Mailing Address - Fax:
Practice Address - Street 1:16707 SE HAIG ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-1421
Practice Address - Country:US
Practice Address - Phone:503-278-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPENDING101YA0400X, 175T00000X
OR112422171R00000X
000000174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171R00000XOther Service ProvidersInterpreter
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist