Provider Demographics
NPI:1750934576
Name:GOLDTHWAITE, MELISSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GOLDTHWAITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 FOSSIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1869
Mailing Address - Country:US
Mailing Address - Phone:909-648-5225
Mailing Address - Fax:
Practice Address - Street 1:750 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4635
Practice Address - Country:US
Practice Address - Phone:214-306-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-21
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty