Provider Demographics
NPI:1003343336
Name:MCDANIEL, MELANIE KAY
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:KAY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 W BRANGUS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5736
Mailing Address - Country:US
Mailing Address - Phone:903-235-8992
Mailing Address - Fax:
Practice Address - Street 1:1378 W BRANGUS WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5736
Practice Address - Country:US
Practice Address - Phone:903-235-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty