Most Relevant Information
Provider Data
| NPI Number: | 1003204827 |
| Provider Name: | MELISSA ANN LAKE PSY.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 103T00000X |
| Specialty: | Psychologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/31/2014 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
4552 W COTTONTAIL RD
PHOENIX
AZ
850861449
Practice Location Phone/Fax
| Phone: | 2012329916 |
| Fax: |
Provider Mailing Location
4552 W COTTONTAIL RD
PHOENIX
AZ
850861449
Provider Mailing Phone/Fax
| Phone: | 2012329916 |
| Fax: |