Individual
MRS. SUSAN MELLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 SATELLITE VW UNIT 603, ROUND ROCK, TX 78665-1592
(512) 862-0687
Mailing address
8610 AXIS DR, AUSTIN, TX 78749-3736
(512) 529-8551
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
204142
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204142
ALL OTHERS
—
Enumeration date
01/08/2022
Last updated
01/08/2022
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