Healthcare Provider Details

I. General information

NPI: 1194972794
Provider Name (Legal Business Name): MELISSA J ALDERDICE CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W LANCASTER AVE STE 204
FORT WORTH TX
76102-3410
US

IV. Provider business mailing address

PO BOX 99371
FORT WORTH TX
76199-0371
US

V. Phone/Fax

Practice location:
  • Phone: 682-885-2170
  • Fax: 817-335-8277
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: