Healthcare Provider Details

I. General information

NPI: 1720831027
Provider Name (Legal Business Name): MEAGEN SHORT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEAGEN ALONSO

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 7TH ST
CLOVIS NM
88101-1708
US

IV. Provider business mailing address

136 HIGHLAND DR
CLOVIS NM
88101-3510
US

V. Phone/Fax

Practice location:
  • Phone: 575-749-5770
  • Fax:
Mailing address:
  • Phone: 575-749-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2025-0898
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: