Provider Demographics
NPI:1407915598
Name:BERKE, MELVYN ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:ALAN
Last Name:BERKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12820 HILLCREST RD
Mailing Address - Street 2:C-226
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1526
Mailing Address - Country:US
Mailing Address - Phone:972-387-0177
Mailing Address - Fax:972-386-8665
Practice Address - Street 1:12820 HILLCREST RD
Practice Address - Street 2:C-226
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1526
Practice Address - Country:US
Practice Address - Phone:972-387-0177
Practice Address - Fax:972-386-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-0190103TC0700X, 103TA0400X, 103TC2200X, 103TF0000X, 103TH0100X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN928Medicare ID - Type Unspecified
TX613601Medicare PIN