Healthcare Provider Details

I. General information

NPI: 1285642397
Provider Name (Legal Business Name): MELBA KREJCI L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 S TEXAS AVE
BRYAN TX
77802-1015
US

IV. Provider business mailing address

1504 TEXAS AVE P.O BOX 4588
BRYAN TX
77805-4588
US

V. Phone/Fax

Practice location:
  • Phone: 979-822-6467
  • Fax: 979-821-9448
Mailing address:
  • Phone: 979-822-6467
  • Fax: 979-821-9448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15282
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: