Provider Demographics
NPI:1245124528
Name:HAHNKE, MELISSA JOY (LAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JOY
Last Name:HAHNKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 E GREENWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4805
Mailing Address - Country:US
Mailing Address - Phone:602-786-5742
Mailing Address - Fax:
Practice Address - Street 1:4646 E GREENWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4805
Practice Address - Country:US
Practice Address - Phone:602-786-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health