Provider Demographics
NPI:1396831095
Name:MECCA, JANET GAYLE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:GAYLE
Last Name:MECCA
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 93846
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-3846
Mailing Address - Country:US
Mailing Address - Phone:505-238-1992
Mailing Address - Fax:505-797-7941
Practice Address - Street 1:127 BRYN MAWR DR SE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2265
Practice Address - Country:US
Practice Address - Phone:505-238-1992
Practice Address - Fax:505-797-7941
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00094791101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100113Medicaid