Provider Demographics
NPI:1801134879
Name:SOULES, MELINDA BETH (LCSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:BETH
Last Name:SOULES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 NW CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7003
Mailing Address - Country:US
Mailing Address - Phone:541-408-5609
Mailing Address - Fax:
Practice Address - Street 1:745 NW MT WASHINGTON DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1574
Practice Address - Country:US
Practice Address - Phone:541-408-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL56311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical