=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811252554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA CALLICOAT CROCI LPC, LAMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2012
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1375 N SCOTTSDALE RD STE 145
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85257-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-646-3247
-----------------------------------------------------
Fax | 480-546-4048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 E SOUTHERN AVE STE. 735
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-5691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-804-0326
-----------------------------------------------------
Fax | 480-804-0083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LAMFT-10349
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC-14161
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------