Melody Jackman, MA, CMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C5858 Issued in OR

Practice address

10700 SW Beaverton Hillsdale Hwy Ste 460
Beaverton, OR 97005-4736

Phone

(503) 999-1362

NPI assigned

Oct 6, 2016

Last updated

Aug 16, 2021By 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 Arts

State licenses

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1891245403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 SW BEAVERTON HILLSDALE HWY STE 460",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054736",
            "telephone_number": "503-999-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 SW BEAVERTON HILLSDALE HWY STE 460",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970054736",
            "telephone_number": "503-999-1362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKMAN",
        "first_name": "MELODY",
        "credential": "MA, CMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-10-06",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C5858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miglena A Ivanova-Shinde
• Ivys Massage and Bodywork
• Katarzyna Barbara Iwan, M.D.
• Naoya Izawa, PSY.D.
• Lisa Jackman
• Cody Jackson, DMD
• Ian Jackson
• Jan Leslie Jackson, PHYSICAL THERAPIST
• Joshua Jackson
• Kathleen Marie Jackson, RDH

• Mental Health Counselor in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.