Provider Demographics
NPI:1417972654
Name:MELESTER, JANICE CAUDILL (PHD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:CAUDILL
Last Name:MELESTER
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:GALAXY COUNSELING CENTER
Mailing Address - Street 2:1021 S. JUPITER RD
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042
Mailing Address - Country:US
Mailing Address - Phone:972-529-9977
Mailing Address - Fax:
Practice Address - Street 1:4715 VIEWRIDGE AVE.
Practice Address - Street 2:VERICARE, SUITE 230
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31544103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83160PMedicare ID - Type Unspecified