Provider Demographics
NPI:1083929228
Name:WIAFE, MELINDA J (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:J
Last Name:WIAFE
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3157 N RAINBOW BLVD
Mailing Address - Street 2:#325
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:918-850-5100
Mailing Address - Fax:866-757-5778
Practice Address - Street 1:5851 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1290
Practice Address - Country:US
Practice Address - Phone:702-830-4029
Practice Address - Fax:702-250-2260
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06763-LCS101YA0400X
OK101YA0400X, 101YM0800X
NVCPC0081101YM0800X
NVCP0081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083929228Medicaid