Provider Demographics
NPI:1598049504
Name:KURUP, MELISSA (LPC-S)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KURUP
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 RESEARCH BLVD STE G3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1821
Mailing Address - Country:US
Mailing Address - Phone:773-968-1641
Mailing Address - Fax:
Practice Address - Street 1:13740 RESEARCH BLVD STE G3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1821
Practice Address - Country:US
Practice Address - Phone:773-968-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002301A101YM0800X
TX71668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health