Healthcare Provider Details

I. General information

NPI: 1629774682
Provider Name (Legal Business Name): MELISSA HUFFMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERAN HUFFMAN

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-443-2173
  • Fax:
Mailing address:
  • Phone: 505-443-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0609
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: