MEDICARE: HEATHER GWEN MELASS MA, LPC, ADHD-CCSP,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	87181	TX

General Provider Information

NPI Number	:	1174114169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GWEN MELASS MA, LPC, ADHD-CCSP,

Provider Business Mailing Address
First Line	:	104 CIRCLE WAY ST STE B
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5200
Country	:	US
Telephone Number	:	979-217-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 CIRCLE WAY ST STE B
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5200
Country	:	US
Telephone Number	:	979-217-1789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/03/2026

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