Provider Demographics
NPI:1871608968
Name:STANDISH, MELISSA HARRELL (MSW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:HARRELL
Last Name:STANDISH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREENWAY PLZ UNIT 3G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-1502
Mailing Address - Country:US
Mailing Address - Phone:713-622-5625
Mailing Address - Fax:281-547-8865
Practice Address - Street 1:3400 BISSONNET ST STE 282
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2100
Practice Address - Country:US
Practice Address - Phone:713-622-5625
Practice Address - Fax:281-547-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164671041C0700X, 1041C0700X
TX002888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00662EMedicare ID - Type Unspecified
R69856Medicare UPIN