Provider Demographics
NPI:1790412955
Name:MCKIBBIN, MELODY (LMHC, LPC, LPCC, CPC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MCKIBBIN
Suffix:
Gender:F
Credentials:LMHC, LPC, LPCC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:ECTOR
Mailing Address - State:TX
Mailing Address - Zip Code:75439-0001
Mailing Address - Country:US
Mailing Address - Phone:903-698-7455
Mailing Address - Fax:903-698-7455
Practice Address - Street 1:708 N MAIN ST APT O
Practice Address - Street 2:
Practice Address - City:ECTOR
Practice Address - State:TX
Practice Address - Zip Code:75439-2040
Practice Address - Country:US
Practice Address - Phone:903-698-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9376101YM0800X
WALH61500996101YM0800X
IN39004978A101YM0800X
IA125140101YM0800X
MTBBH-PCLC-LIC-57423101YM0800X
NVCP5666-R101YM0800X
NMCTB-2024-0317101YM0800X
UT14055716-6004101YM0800X
TX89657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health