Provider Demographics
NPI:1194185827
Name:MELANCON, VICKI (LPC)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MELANCON
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 1:2750 S 8TH ST
Mailing Address - Street 2:BLDG. A
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-7719
Mailing Address - Country:US
Mailing Address - Phone:409-839-1002
Mailing Address - Fax:409-839-1090
Practice Address - Street 1:2750 S 8TH ST
Practice Address - Street 2:BLDG. A
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-7719
Practice Address - Country:US
Practice Address - Phone:409-839-1002
Practice Address - Fax:409-839-1090
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69834101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional