Provider Demographics
NPI:1114230554
Name:MADRID, MELINDA GRACE (LPC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GRACE
Last Name:MADRID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 SURETY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2043
Mailing Address - Country:US
Mailing Address - Phone:915-781-9900
Mailing Address - Fax:915-781-9930
Practice Address - Street 1:6040 SURETY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2043
Practice Address - Country:US
Practice Address - Phone:915-781-9900
Practice Address - Fax:915-781-9930
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional