Provider Demographics
NPI:1326032467
Name:BLANCHARD, MELISSA (MED)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E HEARNE WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1234 S POWER RD
Practice Address - Street 2:#251
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3700
Practice Address - Country:US
Practice Address - Phone:480-854-0844
Practice Address - Fax:480-892-0548
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC0124101YA0400X
AZLPC0034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional