Provider Demographics
NPI:1265869796
Name:GRAMIGNA, MELISSA LYN
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LYN
Last Name:GRAMIGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LYN
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:170 N ARMSTRONG RD
Mailing Address - Street 2:
Mailing Address - City:VENUS
Mailing Address - State:TX
Mailing Address - Zip Code:76084-4852
Mailing Address - Country:US
Mailing Address - Phone:325-232-3021
Mailing Address - Fax:
Practice Address - Street 1:1380 RIVER BEND
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:76247
Practice Address - Country:US
Practice Address - Phone:214-743-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17026101YM0800X
TX251051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical