Provider Demographics
NPI:1689187031
Name:HOUSTON, MELODY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:ANN
Last Name:HOUSTON
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 1:6420 SOUTHWEST BLVD.
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3929
Mailing Address - Country:US
Mailing Address - Phone:817-718-8611
Mailing Address - Fax:
Practice Address - Street 1:6420 SOUTHWEST BLVD.
Practice Address - Street 2:SUITE NUMBER 111
Practice Address - City:FORT WORTH,
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-718-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37793103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist