=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871264374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA GRIFFING LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2021
-----------------------------------------------------
Last Update Date | 10/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13500 MIDWAY RD STE 314
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-813-8096
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13500 MIDWAY RD STE 333
-----------------------------------------------------
City | FARMERS BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-838-1412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 79615
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------