Provider Demographics
NPI:1790412955
Name:MCKIBBIN, MELODY (LMHCA)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MCKIBBIN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W WOODARD ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-3104
Mailing Address - Country:US
Mailing Address - Phone:903-698-7455
Mailing Address - Fax:903-698-7456
Practice Address - Street 1:500 W WOODARD ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3104
Practice Address - Country:US
Practice Address - Phone:903-698-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9376101YM0800X
TX89657101YM0800X, 101YM0800X
WALH61500996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health