Provider Demographics
NPI:1093080095
Name:MELTON, ELLEN CLARICE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:CLARICE
Last Name:MELTON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5355
Mailing Address - Country:US
Mailing Address - Phone:512-850-7191
Mailing Address - Fax:512-864-0232
Practice Address - Street 1:2004 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3240
Practice Address - Country:US
Practice Address - Phone:512-850-7191
Practice Address - Fax:512-864-0232
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional