Healthcare Provider Details

I. General information

NPI: 1780470492
Provider Name (Legal Business Name): MELISSA MCKINNEY LAAC, MS, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 S DESERT VIEW DR
APACHE JUNCTION AZ
85120-9559
US

IV. Provider business mailing address

3491 S DESERT VIEW DR
APACHE JUNCTION AZ
85120-9559
US

V. Phone/Fax

Practice location:
  • Phone: 480-246-0411
  • Fax:
Mailing address:
  • Phone: 480-246-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAAC-15585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: