Provider Demographics
NPI:1700058542
Name:HARBERT, MELISSA RUTH (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RUTH
Last Name:HARBERT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39065 PIONEER BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8088
Mailing Address - Country:US
Mailing Address - Phone:971-220-2645
Mailing Address - Fax:
Practice Address - Street 1:39065 PIONEER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055
Practice Address - Country:US
Practice Address - Phone:971-220-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional