Provider Demographics
NPI:1023232956
Name:ELIESON, MELISA VALERI (LPC)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:VALERI
Last Name:ELIESON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:VALERI
Other - Last Name:ELIESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1716 ROSEBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7318
Mailing Address - Country:US
Mailing Address - Phone:214-293-2936
Mailing Address - Fax:
Practice Address - Street 1:1664 KELLER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3702
Practice Address - Country:US
Practice Address - Phone:817-854-3201
Practice Address - Fax:817-854-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84807LOtherBLUE CROSS BLUE SHIELD
TX9264LLOtherBCBS OF TEXAS