Provider Demographics
NPI:1174998488
Name:GAY, MELINDA (LCDC)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SYBIL LANE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1829
Mailing Address - Country:US
Mailing Address - Phone:903-363-9063
Mailing Address - Fax:903-363-9067
Practice Address - Street 1:2010 SYBIL LN
Practice Address - Street 2:SUITE 130
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1823
Practice Address - Country:US
Practice Address - Phone:903-363-9063
Practice Address - Fax:903-363-9067
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12715101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)