Provider Demographics
NPI:1447754551
Name:CAVAZOS, MELINDA FAYE (MA ,LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:FAYE
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:MA ,LPC
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 34834
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4834
Mailing Address - Country:US
Mailing Address - Phone:210-757-3150
Mailing Address - Fax:800-508-0086
Practice Address - Street 1:10615 PERRIN BEITEL RD STE 801
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3142
Practice Address - Country:US
Practice Address - Phone:210-757-3150
Practice Address - Fax:800-508-0086
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX72943OtherLPC LICENSE