Provider Demographics
NPI:1952705428
Name:DEWLEN, MELISSA MAYBERRY (LPCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAYBERRY
Last Name:DEWLEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAREN
Other - Last Name:MAYBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8644 MOCK HEATHER RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4250
Mailing Address - Country:US
Mailing Address - Phone:972-989-0344
Mailing Address - Fax:
Practice Address - Street 1:6612 GULTON CT NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-888-1686
Practice Address - Fax:505-888-1683
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMCCMH0198061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health