Provider Demographics
NPI:1790115400
Name:ROLLINS, MELISSA KAY (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:BANUELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3833 S STAPLES ST STE N202
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5219
Mailing Address - Country:US
Mailing Address - Phone:361-563-9293
Mailing Address - Fax:361-334-0712
Practice Address - Street 1:3833 S STAPLES ST STE N202
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-563-9293
Practice Address - Fax:361-334-0712
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62123101YM0800X, 101YP2500X, 101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional