1538471974 NPI number — MELISSA ANN CERECERES RN, LMFT-A

Table of content: MELISSA ANN CERECERES RN, LMFT-A (NPI 1538471974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538471974 NPI number — MELISSA ANN CERECERES RN, LMFT-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERECERES
Provider First Name:
MELISSA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, LMFT-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRANDOW
Provider Other First Name:
MELISSA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538471974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 685202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78768-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-773-6164
Provider Business Mailing Address Fax Number:
512-519-4232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4534 W GATE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-773-6164
Provider Business Practice Location Address Fax Number:
512-519-4232
Provider Enumeration Date:
07/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  201578 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 781480 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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