MEDICARE: MELINDA JAMISON LEA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	24617	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073617148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA JAMISON LEA PHD

Provider Business Mailing Address
First Line	:	957 NASA PKWY # 511
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3039
Country	:	US
Telephone Number	:	281-488-0615
Fax Number	:	281-488-1390

Provider Business Practice Location Address
First Line	:	4815 PRESTON TRAILS LN
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3885
Country	:	US
Telephone Number	:	281-488-0615
Fax Number	:	281-488-1390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	10/27/2022

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