Provider Demographics
NPI:1730473984
Name:MELTON, SUZANNE KAY (SUZANNE MELTON LPC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:KAY
Last Name:MELTON
Suffix:
Gender:F
Credentials:SUZANNE MELTON LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4255 BRYANT IRVIN RD
Mailing Address - Street 2:#101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4233
Mailing Address - Country:US
Mailing Address - Phone:817-522-6977
Mailing Address - Fax:817-735-9404
Practice Address - Street 1:4255 BRYANT IRVIN RD
Practice Address - Street 2:#101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4233
Practice Address - Country:US
Practice Address - Phone:817-522-6977
Practice Address - Fax:817-735-9404
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional