Provider Demographics
NPI:1225336332
Name:HARGRAVE, MELISSA MCSWEEN (MS, LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MCSWEEN
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:MS, LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28191
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-8191
Mailing Address - Country:US
Mailing Address - Phone:512-850-2287
Mailing Address - Fax:888-716-3505
Practice Address - Street 1:401 E 53RD ST
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2000
Practice Address - Country:US
Practice Address - Phone:512-850-2287
Practice Address - Fax:888-716-3505
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65223101YM0800X
TX201306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281479001Medicaid