Provider Demographics
NPI:1932804697
Name:HILL, MELLISSA L (MS, LAC)
Entity Type:Individual
Prefix:
First Name:MELLISSA
Middle Name:L
Last Name:HILL
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 E BASELINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4629
Mailing Address - Country:US
Mailing Address - Phone:208-761-4054
Mailing Address - Fax:
Practice Address - Street 1:4864 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4629
Practice Address - Country:US
Practice Address - Phone:208-761-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional