Provider Demographics
NPI:1922753219
Name:AUVINE, MELISSA JEANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEANNE
Last Name:AUVINE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 E FRY BLVD
Mailing Address - Street 2:SUITE C-5 PMB 571
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635
Mailing Address - Country:US
Mailing Address - Phone:520-249-9262
Mailing Address - Fax:
Practice Address - Street 1:25 EL CAMINO REAL STE 4
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2800
Practice Address - Country:US
Practice Address - Phone:520-249-9262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-20629OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS