Provider Demographics
NPI:1104118272
Name:CHEATHAM, MELINDA (LBSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4034
Mailing Address - Country:US
Mailing Address - Phone:325-690-3770
Mailing Address - Fax:325-794-1370
Practice Address - Street 1:949 PLUM ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-4200
Practice Address - Country:US
Practice Address - Phone:325-671-4613
Practice Address - Fax:325-794-1363
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11726171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator