Provider Demographics
NPI:1558674614
Name:KUMMER DAGUE, MELISSA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:KUMMER DAGUE
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 1:2200 MARKET ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1530
Mailing Address - Country:US
Mailing Address - Phone:409-762-8636
Mailing Address - Fax:409-762-4185
Practice Address - Street 1:2200 MARKET ST
Practice Address - Street 2:SUITE 600
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1530
Practice Address - Country:US
Practice Address - Phone:409-762-8636
Practice Address - Fax:409-762-4185
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64087101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health