Provider Demographics
NPI:1164900379
Name:SANDERS-DEVILLIER, MELISSA (MA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SANDERS-DEVILLIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DEVILLIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1805 HIGHWAY 30 E
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77320-5461
Mailing Address - Country:US
Mailing Address - Phone:936-355-3355
Mailing Address - Fax:
Practice Address - Street 1:1805 HIGHWAY 30 E
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-5461
Practice Address - Country:US
Practice Address - Phone:936-355-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77316101YP2500X, 101Y00000X, 101YM0800X, 261QM0850X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399679504Medicaid
TX399679505Medicaid