MEDICARE: MS. MELODY VALENCIA CLARKE MA, LPC

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	101YP2500X	Professional Counselor	19290	TX

General Provider Information

NPI Number	:	1356403232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELODY VALENCIA CLARKE MA, LPC

Provider Business Mailing Address
First Line	:	301 WILCREST DR APT 6704
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1068
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:	713-457-0945

Provider Business Practice Location Address
First Line	:	9100 SOUTHWEST FWY
Second Line	:	SUITE 151
City	:	HOUSTON
State	:	TX
Zip	:	77074-1519
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:	713-457-0945

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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