Provider Demographics
NPI:1518515535
Name:LANE, MELISSA BROOKE
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BROOKE
Last Name:LANE
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 1:12523 D BAR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-8603
Mailing Address - Country:US
Mailing Address - Phone:409-739-7754
Mailing Address - Fax:
Practice Address - Street 1:1506 E WINDING WAY DR STE 110
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5391
Practice Address - Country:US
Practice Address - Phone:832-377-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist