Provider Demographics
NPI:1063177269
Name:JONES, MELISSA A (CRM/PSS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:CRM/PSS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:CEDILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRM/PSS
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:503-224-1044
Mailing Address - Fax:503-621-2235
Practice Address - Street 1:1631 SW COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6025
Practice Address - Country:US
Practice Address - Phone:503-231-2641
Practice Address - Fax:503-231-1654
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105322175T00000X
OR21-CRM-470101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500799872Medicaid