Provider Demographics
NPI:1194733212
Name:GROVE, MELISSA JEAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:GROVE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 MCKINNEY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8212
Mailing Address - Country:US
Mailing Address - Phone:214-520-6308
Mailing Address - Fax:214-521-9172
Practice Address - Street 1:4054 MCKINNEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8212
Practice Address - Country:US
Practice Address - Phone:214-520-6308
Practice Address - Fax:214-521-9172
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83269LOtherBCBS
TX15309 LPCOtherLPC LICENSE