Provider Demographics
NPI:1598166423
Name:BEASON-SMITH, MELISSA (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BEASON-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 PALM RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 KINGWOOD DR
Practice Address - Street 2:SUITE 235
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3001
Practice Address - Country:US
Practice Address - Phone:713-376-5924
Practice Address - Fax:832-383-9721
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist