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General NPI Number Information
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NPI Number | 1518515535
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Entity Type | Individual
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Provider Name | MS. MELISSA BROOKE LANE
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 1506 E WINDING WAY DR STE 110
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5391
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Country | US
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Telephone | 832-377-8813
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Fax |
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Provider Business Mailing Address
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Address Line | 12523 D BAR DR
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City | SANTA FE
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State | TX
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Zip | 77510-8603
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Country | US
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Telephone | 409-739-7754
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 203529
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License Number State | TX
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