Provider Demographics
NPI:1376753749
Name:DILWORTH, MELISSA ANN (LPC-AT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DILWORTH
Suffix:
Gender:F
Credentials:LPC-AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 IRISH OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5604
Mailing Address - Country:US
Mailing Address - Phone:210-545-0541
Mailing Address - Fax:210-731-0395
Practice Address - Street 1:4727 IRISH OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5604
Practice Address - Country:US
Practice Address - Phone:210-545-0541
Practice Address - Fax:210-731-0395
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional