Provider Demographics
NPI:1679460075
Name:CHITOBOLO, CHILANDO MELODY (LPC-A)
Entity type:Individual
Prefix:
First Name:CHILANDO
Middle Name:MELODY
Last Name:CHITOBOLO
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W. 6TH STREET
Mailing Address - Street 2:SUITE 469
Mailing Address - City:FORTWORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102
Mailing Address - Country:US
Mailing Address - Phone:469-759-0875
Mailing Address - Fax:
Practice Address - Street 1:600 W. 6TH STREET
Practice Address - Street 2:SUITE 469
Practice Address - City:FORTWORTH
Practice Address - State:TX
Practice Address - Zip Code:76102
Practice Address - Country:US
Practice Address - Phone:469-759-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health