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General NPI Number Information
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NPI Number | 1174114169
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Entity Type | Individual
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Provider Name | HEATHER GWEN MELASS MA, LPC, ADHD-CCSP,
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Gender | Female
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 129 CIRCLE WAY ST STE 110
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5239
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Country | US
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Telephone | 979-217-1789
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Fax |
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Provider Business Mailing Address
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Address Line | 129 CIRCLE WAY ST STE 110
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5239
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Country | US
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Telephone | 979-217-1789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 87181
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License Number State | TX
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