Provider Demographics
NPI:1821568668
Name:ARMENDARIZ, MELISSA CRYSTAL
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRYSTAL
Last Name:ARMENDARIZ
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 1:7445 W FLEETWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-3031
Mailing Address - Country:US
Mailing Address - Phone:602-600-5069
Mailing Address - Fax:
Practice Address - Street 1:7445 W FLEETWOOD LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85303-3031
Practice Address - Country:US
Practice Address - Phone:602-600-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician