| Doctor Name: | MISS MELISSA TICE |
| NPI Number: | 1700235124 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.T.C. , L.A.T. |
| License Number: | AT5006 |
| Business Practice Address: | 1098 W Main St Lewisville, TX - 750673518 |
| Business Phone Number: | 4694460381 |
| Business Fax Number: | |
| Mailing Address: | 401 N Old Orchard Ln, Apt 231 LEWISVILLE |
| State: | TX |
| Postal Code: | 750673649 |
| Phone Number: | 6824727907 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2016 |
| NPI Last Update Date: | 06/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | AT5006 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |