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MELISSA EDWARDS PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2200
Mailing address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2200

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
36939
TX
103TC0700X
Clinical Psychologist
36939
TX

Other

Enumeration date
01/09/2020
Last updated
10/15/2020
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