Provider Demographics
NPI:1316460967
Name:GOMEZ, MELANIE E
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 CITADEL PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1017
Mailing Address - Country:US
Mailing Address - Phone:210-467-5395
Mailing Address - Fax:210-817-1114
Practice Address - Street 1:1747 CITADEL PLZ STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1017
Practice Address - Country:US
Practice Address - Phone:210-467-5395
Practice Address - Fax:210-817-1114
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81246101YM0800X
TX13828101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)