Provider Demographics
NPI:1306036637
Name:KING, MELINDA PHILEN (MED)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:PHILEN
Last Name:KING
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 ANCHOR DR BLDG 500
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8285
Mailing Address - Country:US
Mailing Address - Phone:409-727-6400
Mailing Address - Fax:409-727-6403
Practice Address - Street 1:7980 ANCHOR DR BLDG 500
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8285
Practice Address - Country:US
Practice Address - Phone:409-727-6400
Practice Address - Fax:409-727-6403
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20253101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186394601Medicaid