Provider Demographics
NPI:1083728539
Name:ZEMENCSIK, MELISSA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ZEMENCSIK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77305-3067
Mailing Address - Country:US
Mailing Address - Phone:936-521-6100
Mailing Address - Fax:936-760-2898
Practice Address - Street 1:1506 FM 2854 RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2206
Practice Address - Country:US
Practice Address - Phone:936-521-6100
Practice Address - Fax:936-760-2898
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18663101YP2500X
TX5158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX73-0032662OtherEMPLOYER IDENTIFICATION NUMBER