Provider Demographics
NPI:1750676730
Name:MELLO ROGERS, KIRA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIRA
Middle Name:S
Last Name:MELLO ROGERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KIRA
Other - Middle Name:S
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7272 WURZBACH RD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4801
Mailing Address - Country:US
Mailing Address - Phone:210-615-8880
Mailing Address - Fax:210-593-9863
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4801
Practice Address - Country:US
Practice Address - Phone:210-615-8880
Practice Address - Fax:210-593-9863
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34957103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34957OtherLICENSE