MEDICARE: MELISSA BORDENKIRCHER LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC23920	AZ

General Provider Information

NPI Number	:	1790499184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BORDENKIRCHER LAC

Provider Business Mailing Address
First Line	:	7982 W MARTHA WAY
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-4350
Country	:	US
Telephone Number	:	623-244-0834
Fax Number	:

Provider Business Practice Location Address
First Line	:	18001 N 79TH AVE STE A10
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8389
Country	:	US
Telephone Number	:	623-244-0834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	06/01/2026

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