Provider Demographics
NPI:1326163924
Name:SUTHERLAND, MELISSA (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 N MAIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5851
Mailing Address - Country:US
Mailing Address - Phone:210-736-2700
Mailing Address - Fax:210-736-2708
Practice Address - Street 1:2118 N MAIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5851
Practice Address - Country:US
Practice Address - Phone:210-736-2700
Practice Address - Fax:210-736-2708
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13572101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional