Provider Demographics
NPI:1114409349
Name:SILLS, MELANIE ODETTE (LCDC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ODETTE
Last Name:SILLS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 FREDERICKSBURG RD STE 137
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-3268
Mailing Address - Country:US
Mailing Address - Phone:210-265-1133
Mailing Address - Fax:210-259-8528
Practice Address - Street 1:3700 FREDERICKSBURG RD STE 137
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-3268
Practice Address - Country:US
Practice Address - Phone:210-265-1133
Practice Address - Fax:210-259-8528
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2767101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)