MEDICARE: MELISSA MARIE LOPEZ-SULLIVAN CLC, DOULA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach
2	172V00000X	Community Health Worker
3	174H00000X	Health Educator
4	174N00000X	Lactation Consultant (Non-RN)		NM
5	374K00000X	Religious Nonmedical Practitioner
6	374J00000X	Doula	0013-2025	NM

General Provider Information

NPI Number	:	1518624964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MARIE LOPEZ-SULLIVAN CLC, DOULA

Provider Business Mailing Address
First Line	:	4367 CALLE AMARILLA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1823
Country	:	US
Telephone Number	:	575-520-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	4367 CALLE AMARILLA
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1823
Country	:	US
Telephone Number	:	575-520-0795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	04/30/2025

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