Provider Demographics
NPI:1467910398
Name:NICHOLSON, MELAKEE L
Entity Type:Individual
Prefix:
First Name:MELAKEE
Middle Name:L
Last Name:NICHOLSON
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 1:6448 E HIGHWAY 290 STE E114
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1076
Mailing Address - Country:US
Mailing Address - Phone:214-585-3002
Mailing Address - Fax:
Practice Address - Street 1:6448 E HIGHWAY 290 STE E114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1076
Practice Address - Country:US
Practice Address - Phone:512-561-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional