Provider Demographics
NPI:1205515764
Name:MELVILLE, TERESA ROSE (CADCI)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ROSE
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:CADCI
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ROSE
Other - Last Name:BATEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8948 SE VALENTINE DR
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3444
Mailing Address - Country:US
Mailing Address - Phone:038-675-8305
Mailing Address - Fax:
Practice Address - Street 1:2403 SE MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:541-900-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health