Provider Demographics
NPI:1104295534
Name:WATKINS, MELISSA (LPCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WATKINS
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 1:2325 HAPPY LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8634
Mailing Address - Country:US
Mailing Address - Phone:575-693-4001
Mailing Address - Fax:
Practice Address - Street 1:809 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4474
Practice Address - Country:US
Practice Address - Phone:575-935-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202Medicaid