Provider Demographics
NPI:1578290631
Name:ISHIO, MELISSA HAY (LCSW)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:HAY
Last Name:ISHIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 SPRING LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-1248
Mailing Address - Country:US
Mailing Address - Phone:254-227-7930
Mailing Address - Fax:
Practice Address - Street 1:14038 CHINA SPRING RD STE 13
Practice Address - Street 2:
Practice Address - City:CHINA SPRING
Practice Address - State:TX
Practice Address - Zip Code:76633-3450
Practice Address - Country:US
Practice Address - Phone:123-346-4495
Practice Address - Fax:512-212-7470
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical