MEDICARE: MELISSA FLORES LPC-I

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	59326	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0029LK	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1194888115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA FLORES LPC-I

Provider Business Mailing Address
First Line	:	PO BOX 890008
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77289-0008
Country	:	US
Telephone Number	:	713-807-1500
Fax Number	:	713-527-8558

Provider Business Practice Location Address
First Line	:	7802 JONES MALTSBERGER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-6919
Country	:	US
Telephone Number	:	210-826-7246
Fax Number	:	210-826-7251

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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