Provider Demographics
NPI:1093817462
Name:HUBNIK, MELODY ANITA (PHD,LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ANITA
Last Name:HUBNIK
Suffix:
Gender:F
Credentials:PHD,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 COLLEYVILLE BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6277
Mailing Address - Country:US
Mailing Address - Phone:817-310-0507
Mailing Address - Fax:817-310-0877
Practice Address - Street 1:6226 COLLEYVILLE BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-6277
Practice Address - Country:US
Practice Address - Phone:817-310-0507
Practice Address - Fax:817-310-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15706101YM0800X
TXO04869005364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist