Provider Demographics
NPI:1275628786
Name:EARLS, MELISSA KAYE (LPC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KAYE
Last Name:EARLS
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:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-0376
Mailing Address - Country:US
Mailing Address - Phone:281-788-7975
Mailing Address - Fax:281-710-4092
Practice Address - Street 1:3335 CARTWRIGHT RD STE 250
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2551
Practice Address - Country:US
Practice Address - Phone:281-788-7975
Practice Address - Fax:281-407-6217
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7120LCOtherBLUE CROS BLUE SHIELD
TX1705899-02Medicaid