Provider Demographics
NPI:1578142550
Name:ROUDKOVSKI, MELANIE (PHD, LPC-S)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:ROUDKOVSKI
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 WOODVINE ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2650
Mailing Address - Country:US
Mailing Address - Phone:903-235-0496
Mailing Address - Fax:
Practice Address - Street 1:445 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6427
Practice Address - Country:US
Practice Address - Phone:903-502-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health