MEDICARE: MRS. M MELISSA ADAMS LCSW

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	16738	TX

General Provider Information

NPI Number	:	1518186238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. M MELISSA ADAMS LCSW

Provider Business Mailing Address
First Line	:	57 MISTLETOE CT
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-4163
Country	:	US
Telephone Number	:	979-297-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 CIRCLE WAY ST
Second Line	:	SUITE E
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5200
Country	:	US
Telephone Number	:	979-297-8565
Fax Number	:	979-299-6626

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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