Provider Demographics
NPI:1255421780
Name:FIVECOAT, MELISSA SUE (LPC, CADC III)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:FIVECOAT
Suffix:
Gender:F
Credentials:LPC, CADC III
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:FIVECOAT-BORGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 NE GREENWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4616
Mailing Address - Country:US
Mailing Address - Phone:541-383-3005
Mailing Address - Fax:541-383-1883
Practice Address - Street 1:375 NW BEAVER ST STE 101
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-447-0707
Practice Address - Fax:541-416-2152
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional