Provider Demographics
NPI:1487930251
Name:GRAYBILL, MELANIE RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RENEE
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7146 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:WALLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77485-9507
Mailing Address - Country:US
Mailing Address - Phone:979-217-1581
Mailing Address - Fax:
Practice Address - Street 1:7146 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:WALLIS
Practice Address - State:TX
Practice Address - Zip Code:77485-9507
Practice Address - Country:US
Practice Address - Phone:979-217-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55470104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker