Provider Demographics
NPI:1770863524
Name:CARTER, MELODY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:LYNN
Last Name:CARTER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13601 S 44TH ST APT 1025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4877
Mailing Address - Country:US
Mailing Address - Phone:480-340-8890
Mailing Address - Fax:
Practice Address - Street 1:13601 S 44TH ST APT 1025
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4877
Practice Address - Country:US
Practice Address - Phone:480-340-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18523101YP2500X
WY1395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY12651509Medicaid