Provider Demographics
NPI:1932594611
Name:MCCARTHY, MELISSA GLOVER
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GLOVER
Last Name:MCCARTHY
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 1:4329 PHEASANT WALK ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-6739
Mailing Address - Country:US
Mailing Address - Phone:817-675-6896
Mailing Address - Fax:
Practice Address - Street 1:4329 PHEASANT WALK ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-6739
Practice Address - Country:US
Practice Address - Phone:817-675-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional