MEDICARE: MENELIK GROUP, LLC

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	:	1760427512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENELIK GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 8747
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77249-8747
Country	:	US
Telephone Number	:	713-695-3742
Fax Number	:	713-695-3742

Provider Business Practice Location Address
First Line	:	1310 FRAWLEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-3428
Country	:	US
Telephone Number	:	713-695-3742
Fax Number	:	713-695-3742

Authorized Official
Title or Position	:	EHAVIOR &SOCIAL SERVICES DIRECTOR
Name	:	MR. MARTIN TIMOTHY WOODARD
Credential	:	LCSW
Telephone Number	:	713-695-3742

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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