| Doctor Name: | MELISSA SHOCKMAN |
| NPI Number: | 1053708776 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | COUNSELING INTERN |
| License Number: | 113066 |
| Business Practice Address: | 10700 Sw Beaverton Hillsdale Hwy Bld 3 Ste 636 Beaverton, OR - 970053019 |
| Business Phone Number: | 5034305870 |
| Business Fax Number: | |
| Mailing Address: | 10700 Sw Beaverton Hillsdale Hwy, Bld 3 Ste 636 BEAVERTON |
| State: | OR |
| Postal Code: | 970053019 |
| Phone Number: | 5034305870 |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2015 |
| NPI Last Update Date: | 04/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 113066 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |