MEDICARE: MELENA ORNELAS AYRES 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	63095	TX

General Provider Information

NPI Number	:	1811538820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELENA ORNELAS AYRES LCSW

Provider Business Mailing Address
First Line	:	4319 FIELDWOOD DR
Second Line	:
City	:	CORINTH
State	:	TX
Zip	:	76208-5242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 N ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-3089
Country	:	US
Telephone Number	:	940-260-0011
Fax Number	:	940-301-3830

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	12/28/2022

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