Individual
MELISSA LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
7325 N 16TH ST STE 110, PHOENIX, AZ 85020-5202
(602) 345-0276
Mailing address
1517 W LOMA LN, PHOENIX, AZ 85021-5443
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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