Provider Demographics
NPI:1912595554
Name:MELENDEZ, LAUREN (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1245 FRANKLIN D ROOSEVELT AVE APT 227
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2139
Mailing Address - Country:US
Mailing Address - Phone:808-779-1979
Mailing Address - Fax:
Practice Address - Street 1:91-1245 FRANKLIN D ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2114
Practice Address - Country:US
Practice Address - Phone:808-779-1979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10744106H00000X
HI911106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist