Healthcare Provider Details

I. General information

NPI: 1457171050
Provider Name (Legal Business Name): MELISSA ZURITA MS, LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 S UNIVERSITY DR STE 201
FT WORTH TX
76109-3700
US

IV. Provider business mailing address

3913 RUNGE CT W
IRVING TX
75038-6654
US

V. Phone/Fax

Practice location:
  • Phone: 972-807-0460
  • Fax:
Mailing address:
  • Phone: 972-807-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number94554
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: