Provider Demographics
NPI:1184497448
Name:HIDDEN CANDLE, PLLC
Entity type:Organization
Organization Name:HIDDEN CANDLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:VALERI
Authorized Official - Last Name:ELIESON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:817-854-3201
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 STE 101
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3760
Practice Address - Country:US
Practice Address - Phone:817-954-3201
Practice Address - Fax:817-854-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty