Melissa Ann Ibanez, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

15780 Issued in TX

Practice address

4525 Glenwood Ave
Deer Park, TX 77536-7901

Phone

(713) 909-9533

NPI assigned

Mar 2, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1023764859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4525 GLENWOOD AVE",
            "city": "DEER PARK",
            "state": "TX",
            "postal_code": "775367901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4525 GLENWOOD AVE",
            "city": "DEER PARK",
            "state": "TX",
            "postal_code": "775367901",
            "telephone_number": "713-909-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBANEZ",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "credential": "LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-02",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "15780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mibanez@cenikor.org",
            "affiliation": "Y",
            "affiliationName": "Cenikor Foundation",
            "address_1": "4525 Glenwood Ave",
            "city": "Deer Park",
            "state": "TX",
            "country_code": "US",
            "postal_code": "775367901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Deer Park, TX
• Providers in Deer Park, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.