Provider Demographics
NPI:1134398597
Name:BUCHAKLIAN, MELANIE A (LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:A
Last Name:BUCHAKLIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:A
Other - Last Name:GIRAGOSIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 W RIVER WOODS PKWY
Mailing Address - Street 2:3RD FL
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1060
Mailing Address - Country:US
Mailing Address - Phone:414-465-3091
Mailing Address - Fax:414-465-4842
Practice Address - Street 1:1320 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1978
Practice Address - Country:US
Practice Address - Phone:262-687-2222
Practice Address - Fax:262-687-2495
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43706800Medicaid