Provider Demographics
NPI:1760227003
Name:HOUSE, MELISSA ANN (QMHA-I)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:QMHA-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9702
Mailing Address - Country:US
Mailing Address - Phone:541-997-3212
Mailing Address - Fax:
Practice Address - Street 1:2625 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9702
Practice Address - Country:US
Practice Address - Phone:541-997-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-QMHA-I-003712106E00000X, 171M00000X
OR105866175T00000X
ORTHW000105866172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist