Provider Demographics
NPI:1689319816
Name:MERON, MADISON G (MA, MFTA, LMHCA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:G
Last Name:MERON
Suffix:
Gender:F
Credentials:MA, MFTA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 NE 15TH AVE # 458
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2356
Mailing Address - Country:US
Mailing Address - Phone:503-489-8236
Mailing Address - Fax:
Practice Address - Street 1:3519 NE 15TH AVE # 458
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2356
Practice Address - Country:US
Practice Address - Phone:503-489-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9213106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor