Provider Demographics
NPI:1124703459
Name:FEATHERLY, MELANIE (LCDC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:FEATHERLY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 S SHORE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2934
Mailing Address - Country:US
Mailing Address - Phone:832-932-3530
Mailing Address - Fax:409-750-7634
Practice Address - Street 1:2555 S SHORE BLVD STE C
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2934
Practice Address - Country:US
Practice Address - Phone:832-932-3530
Practice Address - Fax:409-750-7634
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)