Provider Demographics
NPI:1285068163
Name:MINTZ, MELISSA GOLDBERG (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GOLDBERG
Last Name:MINTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 ROBINHOOD ST STE 145
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2594
Mailing Address - Country:US
Mailing Address - Phone:713-553-8708
Mailing Address - Fax:
Practice Address - Street 1:2503 ROBINHOOD ST STE 145
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2594
Practice Address - Country:US
Practice Address - Phone:713-553-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX37390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program