Provider Demographics
NPI:1669139317
Name:MELBY, LYNDA
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:MELBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51633 KARANKAWA CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1126
Mailing Address - Country:US
Mailing Address - Phone:912-320-1011
Mailing Address - Fax:
Practice Address - Street 1:304 S 22ND ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-4726
Practice Address - Country:US
Practice Address - Phone:254-493-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health