Provider Demographics
NPI:1134343536
Name:MEDINA, MELISSA (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MEDINA
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 1:1802 GREENGRASS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1120
Mailing Address - Country:US
Mailing Address - Phone:713-303-5144
Mailing Address - Fax:713-723-7303
Practice Address - Street 1:5505 W OREM DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-1276
Practice Address - Country:US
Practice Address - Phone:832-828-3420
Practice Address - Fax:713-723-7303
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical