Provider Demographics
NPI:1669224721
Name:MELENDES, TROY ALEXANDER (PHD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ALEXANDER
Last Name:MELENDES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:TROY
Other - Middle Name:ALEXANDER
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:971 E DAVA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-4763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:971 E DAVA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-4763
Practice Address - Country:US
Practice Address - Phone:602-576-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006808103TC0700X
AZPSY-005585103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical