Healthcare Provider Details

I. General information

NPI: 1508064544
Provider Name (Legal Business Name): MELONEY NUNEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7421 N 175TH AVE
WADDELL AZ
85355-9832
US

IV. Provider business mailing address

7421 N 175TH AVE
WADDELL AZ
85355-9832
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-7111
  • Fax:
Mailing address:
  • Phone: 623-935-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10938
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: