Melissa Layne Tavakoldavani, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

65472 Issued in TX

Practice address

5751 Kroger Dr
Suite 269
Fort Worth, TX 76244-5632

Phone

(817) 812-2880

NPI assigned

Aug 16, 2012

Last updated

Aug 16, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Logos Services, LLC

  • Mental Health Counselor
  • Fort Worth, TX
  • NPI 1215292081
  NPD (past)

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1427306828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5751 KROGER DR",
            "address_2": "SUITE 269",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445632",
            "telephone_number": "817-812-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5751 KROGER DR",
            "address_2": "SUITE 269",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762445632",
            "telephone_number": "817-812-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKOLDAVANI",
        "first_name": "MELISSA",
        "middle_name": "LAYNE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "65472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leilani Tatum, NP
• Lyndsey Garrison Tatum, M.S., CCC-SLP
• Ross Tatum, M.D.
• Ryan Michael Taube, DO
• Kelly Tausend, APRN-FNP
• Kayla Tavares, D.D.S.
• Ereny Tawfik
• Taylor Made Integrative Therapy
• Victoria Taylor-Gonzalez, ATC, LAT
• Alice Taylor, MA

• Mental Health Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.