=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013280270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE DAWN EPP LPC, LMFT, RPT-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2012
-----------------------------------------------------
Last Update Date | 02/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2485 E SOUTHLAKE BLVD 220
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-6686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-594-7474
-----------------------------------------------------
Fax | 940-321-3920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3505 MARQUETTE DR
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-594-7474
-----------------------------------------------------
Fax | 940-321-3920
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 10252
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 2712
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------