Provider Demographics
NPI:1720237860
Name:WADEN, MELISSA DAWN (MSSW, LMSW,)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DAWN
Last Name:WADEN
Suffix:
Gender:F
Credentials:MSSW, LMSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 BISON TRL
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6703
Mailing Address - Country:US
Mailing Address - Phone:336-317-0530
Mailing Address - Fax:817-255-7130
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:682-432-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX# 556081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical