Healthcare Provider Details

I. General information

NPI: 1053271635
Provider Name (Legal Business Name): MELISSA GONZALEZ-HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 RIVERSTONE BLVD STE 100
MISSOURI CITY TX
77459-4723
US

IV. Provider business mailing address

4010 KNOTTYNOLD LN
HOUSTON TX
77053-1411
US

V. Phone/Fax

Practice location:
  • Phone: 817-984-8655
  • 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: