Provider Demographics
NPI:1538471974
Name:CERECERES, MELISSA ANN (RN, LMFT-A)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:CERECERES
Suffix:
Gender:F
Credentials:RN, LMFT-A
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:BRANDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 685202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78768-5202
Mailing Address - Country:US
Mailing Address - Phone:512-773-6164
Mailing Address - Fax:512-519-4232
Practice Address - Street 1:4534 W GATE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1485
Practice Address - Country:US
Practice Address - Phone:512-773-6164
Practice Address - Fax:512-519-4232
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201578106H00000X
TX781480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse