Provider Demographics
NPI:1437804721
Name:MELIA, SHELLY LEE
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:LEE
Last Name:MELIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3340
Mailing Address - Country:US
Mailing Address - Phone:817-944-2129
Mailing Address - Fax:
Practice Address - Street 1:906 ROYAL CT
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3340
Practice Address - Country:US
Practice Address - Phone:817-944-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional