MEDICARE: MELISSA CHILDERS-WHITE

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	101Y00000X	Counselor	2015	TX
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1093339822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CHILDERS-WHITE

Provider Business Mailing Address
First Line	:	212 VILLAGE CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 VILLAGE CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2824
Country	:	US
Telephone Number	:	210-846-4536
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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Directions to “ MELISSA CHILDERS-WHITE ” Practice Location

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