Provider Demographics
NPI:1063035293
Name:METELAK, CANDY LYNN (CRM, PRC, CADC I)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:LYNN
Last Name:METELAK
Suffix:
Gender:F
Credentials:CRM, PRC, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1328
Mailing Address - Country:US
Mailing Address - Phone:971-202-7760
Mailing Address - Fax:503-239-8406
Practice Address - Street 1:10362 SW MCDONALD ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4863
Practice Address - Country:US
Practice Address - Phone:971-202-7964
Practice Address - Fax:503-639-3973
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20-P-02101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)