Provider Demographics
NPI:1609291921
Name:BARTH, MELINDA MAY (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MAY
Last Name:BARTH
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12836 LOMAS BLVD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-6200
Mailing Address - Country:US
Mailing Address - Phone:505-710-6530
Mailing Address - Fax:505-227-8993
Practice Address - Street 1:12836 LOMAS BLVD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-6200
Practice Address - Country:US
Practice Address - Phone:505-710-6530
Practice Address - Fax:505-227-8993
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0209091101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMBN311Medicaid