Provider Demographics
NPI:1558693473
Name:BRIMHALL, MELODY LEE (MAPC,LPC,LISAC,NCC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:LEE
Last Name:BRIMHALL
Suffix:
Gender:F
Credentials:MAPC,LPC,LISAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 E FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5121
Mailing Address - Country:US
Mailing Address - Phone:480-980-0059
Mailing Address - Fax:
Practice Address - Street 1:207 N GILBERT RD STE 107
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5814
Practice Address - Country:US
Practice Address - Phone:480-980-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11873101YA0400X
AZLPC-13383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)