MEDICARE: MELIOR COUNSELING PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1285395301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELIOR COUNSELING PLLC

Provider Business Mailing Address
First Line	:	101 BELMONT ST UNIT 79493
Second Line	:
City	:	SAGINAW
State	:	TX
Zip	:	76179-7925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5341 BRENTLAWN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-5506
Country	:	US
Telephone Number	:	682-757-8700
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	CATRISKA CANDICE RUCKER
Credential	:	LCSW
Telephone Number	:	682-757-8700

Provider Enumeration Date	:	01/02/2022
Last Update Date	:	01/02/2022

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