Provider Demographics
NPI:1649013970
Name:ACKLEY, MELISSA DAWN (MA ART THERAPY)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:MA ART THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SE 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1647
Mailing Address - Country:US
Mailing Address - Phone:512-757-6470
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2617
Practice Address - Country:US
Practice Address - Phone:971-394-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional