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General NPI Number Information
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NPI Number | 1275241283
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Entity Type | Individual
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Provider Name | MELODY NAIT SIDENAS LPC
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Gender | Female
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Dates
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Enumeration Date | 11/08/2022
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 900 NE LOOP 410 STE D200
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1407
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Country | US
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Telephone | 210-822-2600
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Fax | 210-822-2685
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Provider Business Mailing Address
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Address Line | 7912 MAPLE LEAF
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City | SAN ANTONIO
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State | TX
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Zip | 78254-5484
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Country | US
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Telephone | 907-250-2392
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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 | 90276
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 90276
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License Number State | TX
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