Healthcare Provider Details

I. General information

NPI: 1518624964
Provider Name (Legal Business Name): MELISSA MARIE LOPEZ-SULLIVAN CLC, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA MARIE BRICE CLC, DOULA

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4367 CALLE AMARILLA
LAS CRUCES NM
88011-1823
US

IV. Provider business mailing address

4367 CALLE AMARILLA
LAS CRUCES NM
88011-1823
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-0795
  • Fax:
Mailing address:
  • Phone: 575-520-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number0013-2025
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: