Healthcare Provider Details

I. General information

NPI: 1265366835
Provider Name (Legal Business Name): MELODY HOSTASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 LEAGUE LINE RD
CONROE TX
77304-3833
US

IV. Provider business mailing address

4008 KINGSFERRY DR
ARLINGTON TX
76016-3606
US

V. Phone/Fax

Practice location:
  • Phone: 936-270-8278
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: