Marie Mellberg, MS, CRC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

C4927 Issued in OR

Practice address

7415 N Oatman Ave
Portland, OR 97217

Phone

(503) 789-5092

Fax

(503) 289-0943

NPI assigned

Oct 12, 2015

Last updated

Aug 15, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1821469214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7415 N OATMAN AVE.",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972171213",
            "telephone_number": "503-789-5092",
            "fax_number": "503-289-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7415 N OATMAN AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97217",
            "telephone_number": "503-789-5092",
            "fax_number": "503-289-0943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1722 NW Raleigh St",
            "address_2": "#411",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972091753",
            "country_code": "US",
            "telephone_number": "503-789-5092",
            "fax_number": "503-289-0943",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MELLBERG",
        "first_name": "MARIE",
        "credential": "MS, CRC, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-12",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OR",
            "license": "C4927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa J. Wages, DDS PC (SW Portland Pediatric Dentistry)
• Melissa M. Beadnell D.M.D. P.C. (Beadnell Family Dentistry)
• Melissa Miesen, PC
• Melissa Yeary LPC, LLC
• Carole Anne Melkonian, LAC, RN
• Assefash Melles, MS
• Laura Mellick, MD
• Michael James Mellick
• Randall Mello, PHARMD
• Margret Lee Mellon, LMT

• Professional Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Professional Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.