Provider Demographics
NPI:1972865210
Name:MCVICKER, MELISSA L (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:MCVICKER
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21015 MARKET RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4978
Mailing Address - Country:US
Mailing Address - Phone:210-570-4886
Mailing Address - Fax:
Practice Address - Street 1:21015 MARKET RDG STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4979
Practice Address - Country:US
Practice Address - Phone:210-570-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist