Provider Demographics
NPI:1104622091
Name:SPENCE, MELISSA CATHERINE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:CATHERINE
Last Name:SPENCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:CATHERINE
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6001 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-4426
Mailing Address - Country:US
Mailing Address - Phone:512-656-5414
Mailing Address - Fax:
Practice Address - Street 1:6001 MARILYN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-4426
Practice Address - Country:US
Practice Address - Phone:512-656-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1507481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical