Provider Demographics
NPI:1467106187
Name:BIRDWELL, MELISSA RAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAYE
Last Name:BIRDWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RAYE
Other - Last Name:MOTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1605 JOE MORSE DR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-4754
Mailing Address - Country:US
Mailing Address - Phone:254-462-3217
Mailing Address - Fax:
Practice Address - Street 1:1605 JOE MORSE DR
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-4754
Practice Address - Country:US
Practice Address - Phone:254-462-3217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67485104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty