Provider Demographics
NPI:1891749941
Name:MAMOLA, MELANIE B (PROFCOUNSELOR ASS)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:B
Last Name:MAMOLA
Suffix:
Gender:F
Credentials:PROFCOUNSELOR ASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9670 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3307
Mailing Address - Country:US
Mailing Address - Phone:971-229-4009
Mailing Address - Fax:866-324-6009
Practice Address - Street 1:9670 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3307
Practice Address - Country:US
Practice Address - Phone:971-229-4009
Practice Address - Fax:866-324-6009
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
ORR7605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health