Provider Demographics
NPI:1417090010
Name:GREGG, MELANIE YARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:YARD
Last Name:GREGG
Suffix:
Gender:F
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:PO BOX 35684
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77235-5684
Mailing Address - Country:US
Mailing Address - Phone:713-408-2414
Mailing Address - Fax:
Practice Address - Street 1:3100 WESLAYAN ST STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5727
Practice Address - Country:US
Practice Address - Phone:713-408-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34333103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC047F7OtherBCBS
NC6000984Medicaid