Provider Demographics
NPI:1811252554
Name:CROCI, MELINDA CALLICOAT (LPC, LAMFT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:CALLICOAT
Last Name:CROCI
Suffix:
Gender:F
Credentials:LPC, LAMFT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:K
Other - Last Name:GREENBANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E SOUTHERN AVE
Mailing Address - Street 2:STE. 735
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5691
Mailing Address - Country:US
Mailing Address - Phone:480-804-0326
Mailing Address - Fax:480-804-0083
Practice Address - Street 1:1375 N SCOTTSDALE RD STE 145
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3413
Practice Address - Country:US
Practice Address - Phone:844-646-3247
Practice Address - Fax:480-546-4048
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10349106H00000X
AZLPC-14161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ816306Medicaid