Provider Demographics
NPI:1427726371
Name:DEAN, MELISA KALENE (MA)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:KALENE
Last Name:DEAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1920
Mailing Address - Country:US
Mailing Address - Phone:817-253-4095
Mailing Address - Fax:
Practice Address - Street 1:2214 EMERY ST STE 510
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2476
Practice Address - Country:US
Practice Address - Phone:940-202-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional