Provider Demographics
NPI:1861639890
Name:MELANCON, ARTHEMEASE BLOXSON (LCSW)
Entity Type:Individual
Prefix:
First Name:ARTHEMEASE
Middle Name:BLOXSON
Last Name:MELANCON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19318 DIAMOND PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8413
Mailing Address - Country:US
Mailing Address - Phone:504-390-0250
Mailing Address - Fax:832-447-8658
Practice Address - Street 1:19318 DIAMOND PARK CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-8413
Practice Address - Country:US
Practice Address - Phone:504-390-0250
Practice Address - Fax:832-447-8658
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX419881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical