Basic Information
| Provider Information | |||||||||
| NPI: | 1568691483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTOINE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MACKLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13930 SUMMERFAIR CT | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770445997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322822071 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3811 LYONS AVE | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770208306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133517360 | ||||||||
| FaxNumber: | 7133517361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2009 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | P8405 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 080462703 | 05 | TX | MEDICAID |