Provider Demographics
NPI:1285642397
Name:KREJCI, MELBA (LPC)
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:
Last Name:KREJCI
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 1:1504 TEXAS AVE
Mailing Address - Street 2:P.O BOX 4588
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-4588
Mailing Address - Country:US
Mailing Address - Phone:979-822-6467
Mailing Address - Fax:979-821-9448
Practice Address - Street 1:1504 S TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1015
Practice Address - Country:US
Practice Address - Phone:979-822-6467
Practice Address - Fax:979-821-9448
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15282101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health