Basic Information
Provider Information
NPI: 1629317839
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BUTTERFIELD
FirstName: MELISSA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA QMHP LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3325 HAROLD DR NE
Address2:  
City: SALEM
State: OR
PostalCode: 973051339
CountryCode: US
TelephoneNumber: 5033632021
FaxNumber: 5033634820
Practice Location
Address1: 3325 HAROLD DR NE
Address2:  
City: SALEM
State: OR
PostalCode: 973051339
CountryCode: US
TelephoneNumber: 5033632021
FaxNumber: 5033634820
Other Information
ProviderEnumerationDate: 02/07/2013
LastUpdateDate: 02/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XT0206ORY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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