Provider Demographics
NPI:1336864180
Name:CHEN, MELINDA II (SOLE- PROPRIETER)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CHEN
Suffix:II
Gender:F
Credentials:SOLE- PROPRIETER
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:PSYCHOLOGY COUNSELIN
Mailing Address - Street 1:9300 JOHN HICKMAN PKWY STE 1204
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5944
Mailing Address - Country:US
Mailing Address - Phone:214-308-9604
Mailing Address - Fax:
Practice Address - Street 1:9300 JOHN HICKMAN PKWY STE 1204
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5944
Practice Address - Country:US
Practice Address - Phone:214-308-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCO22-00135173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCO22-00135Medicaid