Provider Demographics
NPI:1992490346
Name:AVITIA, MELISSA (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:AVITIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 E RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-7372
Mailing Address - Country:US
Mailing Address - Phone:956-720-9687
Mailing Address - Fax:
Practice Address - Street 1:5630 E RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78542-7372
Practice Address - Country:US
Practice Address - Phone:956-720-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health