Provider Demographics
NPI:1659846376
Name:GOMEZ PEREZ, MELANIE ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:GOMEZ PEREZ
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 1:620 N BELL ST
Mailing Address - Street 2:
Mailing Address - City:BROWNFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79316-3538
Mailing Address - Country:US
Mailing Address - Phone:512-525-3169
Mailing Address - Fax:
Practice Address - Street 1:620 N BELL ST
Practice Address - Street 2:
Practice Address - City:BROWNFIELD
Practice Address - State:TX
Practice Address - Zip Code:79316-3538
Practice Address - Country:US
Practice Address - Phone:512-525-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX523711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical