Provider Demographics
NPI:1164741534
Name:MADRID, MELYNDA DENICE (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MELYNDA
Middle Name:DENICE
Last Name:MADRID
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67638
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-7638
Mailing Address - Country:US
Mailing Address - Phone:505-306-2257
Mailing Address - Fax:833-837-3627
Practice Address - Street 1:10408 CALLE ALMA NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1366
Practice Address - Country:US
Practice Address - Phone:505-306-2257
Practice Address - Fax:833-837-3627
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0132101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional