Provider Demographics
NPI:1679113518
Name:MELISSA EARLS, LPC
Entity Type:Organization
Organization Name:MELISSA EARLS, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:EARLS
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC-S
Authorized Official - Phone:281-788-7975
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-0376
Mailing Address - Country:US
Mailing Address - Phone:281-788-7975
Mailing Address - Fax:281-407-6217
Practice Address - Street 1:3335 CARTWRIGHT RD STE 250
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2551
Practice Address - Country:US
Practice Address - Phone:281-788-7975
Practice Address - Fax:281-407-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170589902Medicaid