Basic Information
| Provider Information | |||||||||
| NPI: | 1356403232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLARKE | ||||||||
| FirstName: | MELODY | ||||||||
| MiddleName: | VALENCIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 WILCREST DR APT 6704 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770421068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134574372 | ||||||||
| FaxNumber: | 7134570945 | ||||||||
| Practice Location | |||||||||
| Address1: | 9100 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 151 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770741519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134574372 | ||||||||
| FaxNumber: | 7134570945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 19290 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.