Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC-12114 | AZ |
NPI | 1003087941 |
---|---|
Provider Name | Melinda Chapin |
First Address | Phoenix, AZ 85020-4609 |
Second Address | Phoenix, AZ 85019-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 19/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LPC-12114 | AZBBHE LICENSE (01) | AZ |