Provider Demographics
NPI:1821709973
Name:MELVIN, MICHELLE LYNNETTE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNETTE
Last Name:MELVIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 110TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3843
Mailing Address - Country:US
Mailing Address - Phone:307-871-1877
Mailing Address - Fax:
Practice Address - Street 1:5701 AVENUE P
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3674
Practice Address - Country:US
Practice Address - Phone:806-363-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80856101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional