Individual
MELISSA MIRACLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
18765 SW BOONES FERRY RD STE 100, TUALATIN, OR 97062-8607
(503) 612-1000
Mailing address
29304 SW BROWN RD, WILSONVILLE, OR 97070-3008
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C3456
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C3456
LPC
OR
Enumeration date
02/01/2023
Last updated
02/01/2023
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