Provider Demographics
NPI:1861105538
Name:FREEMAN, MELANIE CORA (LMFT-A)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:CORA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S LAMAR BLVD
Mailing Address - Street 2:STE. D109 #457
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-351-3113
Mailing Address - Fax:512-887-3970
Practice Address - Street 1:602 13TH ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-2005
Practice Address - Country:US
Practice Address - Phone:512-994-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist