Provider Demographics
NPI:1063504306
Name:GILES, MELISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:GILES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:STE 600
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3504
Mailing Address - Country:US
Mailing Address - Phone:713-592-9098
Mailing Address - Fax:713-592-9266
Practice Address - Street 1:6565 WEST LOOP S
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:713-592-8952
Practice Address - Fax:713-592-9266
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30085103TS0200X
TX25540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN229242OtherCOMPSYCH
TN0023EOtherBLUE CROSS BLUE SHIELD
TXP000024E6Medicaid
TX179704OtherMENTAL HEALTH NETWORK
TX00023EMedicare ID - Type Unspecified