Provider Demographics
NPI:1396161451
Name:MANRIQUEZ, MELISSA G (LMSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:MANRIQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5200
Mailing Address - Country:US
Mailing Address - Phone:713-910-5437
Mailing Address - Fax:713-910-5445
Practice Address - Street 1:8021 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5200
Practice Address - Country:US
Practice Address - Phone:713-774-5437
Practice Address - Fax:713-774-5445
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58593171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator