Provider Demographics
NPI:1467744946
Name:ESTAVILLO, MELISSA C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:C
Last Name:ESTAVILLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6245 N 24TH PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2024
Mailing Address - Country:US
Mailing Address - Phone:480-999-7070
Mailing Address - Fax:480-658-2722
Practice Address - Street 1:6245 N 24TH PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2024
Practice Address - Country:US
Practice Address - Phone:480-999-7070
Practice Address - Fax:480-658-2722
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4179103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical