Provider Demographics
NPI:1982077236
Name:PATEL, MELISSA (LMSW, LCDC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BEAR CREEK PKWY APT 1206
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5217
Mailing Address - Country:US
Mailing Address - Phone:214-868-8068
Mailing Address - Fax:
Practice Address - Street 1:105 KATHRYN DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11498101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66805OtherLICENSED MASTER SOCIAL WORKER
TX11498OtherLICENSED CHEMICAL DEPENDENCY COUNSELOR