Provider Demographics
NPI:1275241283
Name:NAIT SIDENAS, MELODY (LPC-A)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:NAIT SIDENAS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8122 ROYAL FLD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3318
Mailing Address - Country:US
Mailing Address - Phone:907-250-2392
Mailing Address - Fax:
Practice Address - Street 1:14607 SAN PEDRO AVE STE 295
Practice Address - Street 2:
Practice Address - City:HILL COUNTRY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:78232-4356
Practice Address - Country:US
Practice Address - Phone:907-250-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90276101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor