Healthcare Provider Details

I. General information

NPI: 1780288241
Provider Name (Legal Business Name): MELISSA TOTAH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 N MOPAC EXPY STE 604
AUSTIN TX
78759-8347
US

IV. Provider business mailing address

9631 COVEY RIDGE LN
AUSTIN TX
78758-5818
US

V. Phone/Fax

Practice location:
  • Phone: 512-350-6236
  • Fax:
Mailing address:
  • Phone: 512-748-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: