Healthcare Provider Details

I. General information

NPI: 1194948042
Provider Name (Legal Business Name): MELISSA NICOLE LAKIN M.C., LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N MILLER RD
SCOTTSDALE AZ
85251-3619
US

IV. Provider business mailing address

8101 E CAMBRIDGE AVE
SCOTTSDALE AZ
85257-1722
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-4247
  • Fax:
Mailing address:
  • Phone: 623-203-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-11930
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: