Provider Demographics
NPI:1659533198
Name:GRAHAM, MELISSA DAVIS (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAVIS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 LINSEY CV
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-5886
Mailing Address - Country:US
Mailing Address - Phone:830-798-6112
Mailing Address - Fax:
Practice Address - Street 1:110 LINSEY CV
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-5886
Practice Address - Country:US
Practice Address - Phone:830-798-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health