Healthcare Provider Details

I. General information

NPI: 1780657296
Provider Name (Legal Business Name): MELANIE COPELAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 LLANO ST STE B
SANTA FE NM
87505-5415
US

IV. Provider business mailing address

1704 LLANO ST STE B
SANTA FE NM
87505-5415
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-0726
  • Fax:
Mailing address:
  • Phone: 505-424-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68747
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06335
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09927276
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10269
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16357
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00006719
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: