Provider Demographics
NPI:1588771406
Name:CALDWELL, MELISSA K (LPC, ATR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 GATEWAY BLVD STE 349
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3546
Mailing Address - Country:US
Mailing Address - Phone:972-918-9588
Mailing Address - Fax:972-918-9069
Practice Address - Street 1:1701 GATEWAY BLVD STE 349
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3546
Practice Address - Country:US
Practice Address - Phone:972-918-9588
Practice Address - Fax:972-918-9069
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5398LCOtherBLUE CROSS OF TEXAS