=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265950430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA S MAGYAR PHD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2017
-----------------------------------------------------
Last Update Date | 09/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3201 UNIVERSITY DR E STE 200
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-446-2566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 UNIVERSITY DR E STE 200
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77802-3431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST/BUSINESS OWNER
-----------------------------------------------------
Name | MELISSA MAGYAR
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 979-446-2566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 37405
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------