Provider Demographics
NPI:1639771512
Name:AMINI-HAJIBASHI, MELANIE TIFFANY (LPC-IT, NCC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:TIFFANY
Last Name:AMINI-HAJIBASHI
Suffix:
Gender:F
Credentials:LPC-IT, NCC
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:TIFFANY
Other - Last Name:AMINI-HAJIBASHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:829 N CASS ST APT 11
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3932
Mailing Address - Country:US
Mailing Address - Phone:414-265-6691
Mailing Address - Fax:
Practice Address - Street 1:8901 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1706
Practice Address - Country:US
Practice Address - Phone:414-265-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4812226101YM0800X
WI8699-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health