Provider Demographics
NPI:1447270723
Name:MELCHER, MARIBETH B (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:B
Last Name:MELCHER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21714 HARDY OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4838
Mailing Address - Country:US
Mailing Address - Phone:210-340-5533
Mailing Address - Fax:210-494-7007
Practice Address - Street 1:21714 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4838
Practice Address - Country:US
Practice Address - Phone:210-340-5533
Practice Address - Fax:210-494-7007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC #14436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional