Healthcare Provider Details

I. General information

NPI: 1588594238
Provider Name (Legal Business Name): MELISSA LEEANN MUNCY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WYATT DR
LAS CRUCES NM
88005-2925
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3448
  • Fax:
Mailing address:
  • Phone: 575-526-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0540
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: