Healthcare Provider Details

I. General information

NPI: 1649616772
Provider Name (Legal Business Name): MELVIN GABRIEL ANAYA LMHC, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W 2ND ST STE 4
ROSWELL NM
88201
US

IV. Provider business mailing address

PO BOX 8075
ROSWELL NM
88202-8075
US

V. Phone/Fax

Practice location:
  • Phone: 575-317-5571
  • Fax:
Mailing address:
  • Phone: 575-317-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0117781
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0193371
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0092621
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: