Provider Demographics
NPI:1184241598
Name:TONG, MELLISSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELLISSA
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 DEEP EDDY AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4555
Mailing Address - Country:US
Mailing Address - Phone:512-956-6463
Mailing Address - Fax:
Practice Address - Street 1:508 DEEP EDDY AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4555
Practice Address - Country:US
Practice Address - Phone:512-956-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSYC.PY.60876120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical