Provider Demographics
NPI:1558540484
Name:JEWELL, MELINDA DIANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:DIANE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 JEWELL ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-5815
Mailing Address - Country:US
Mailing Address - Phone:870-729-1212
Mailing Address - Fax:870-729-1223
Practice Address - Street 1:3220 JEWELL ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5815
Practice Address - Country:US
Practice Address - Phone:870-729-1212
Practice Address - Fax:870-729-1223
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0903019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional