MEDICARE: MELISSA ANN DILWORTH LPC-AT

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	101YP2500X	Professional Counselor	17604	TX

General Provider Information

NPI Number	:	1376753749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN DILWORTH LPC-AT

Provider Business Mailing Address
First Line	:	4727 IRISH OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5604
Country	:	US
Telephone Number	:	210-545-0541
Fax Number	:	210-731-0395

Provider Business Practice Location Address
First Line	:	4727 IRISH OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5604
Country	:	US
Telephone Number	:	210-545-0541
Fax Number	:	210-731-0395

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/09/2007

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