MEDICARE: SUSAN ELAINE MELTON 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	101Y00000X	Counselor	86571	TX

General Provider Information

NPI Number	:	1457202749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ELAINE MELTON LPC

Provider Business Mailing Address
First Line	:	3016 CRESTWAY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5256
Country	:	US
Telephone Number	:	682-272-1327
Fax Number	:	682-272-1327

Provider Business Practice Location Address
First Line	:	1452 HUGHES RD
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-7366
Country	:	US
Telephone Number	:	682-503-1788
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	04/14/2026

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