Provider Demographics
NPI:1053886028
Name:ANDERSON, MELISSA DENISE (RBT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DENISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-9500
Mailing Address - Country:US
Mailing Address - Phone:346-302-8089
Mailing Address - Fax:850-607-6932
Practice Address - Street 1:2947 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-9500
Practice Address - Country:US
Practice Address - Phone:346-302-8089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional