Individual
MELISSA ANN LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
4552 W COTTONTAIL RD, PHOENIX, AZ 85086-1449
(201) 232-9916
Mailing address
4552 W COTTONTAIL RD, PHOENIX, AZ 85086-1449
(201) 232-9916
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001533
AHCCCS
AZ
Enumeration date
12/31/2014
Last updated
07/21/2022
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