Provider Demographics
NPI:1124697008
Name:MELENDEZ, JOHN CELSO (MA, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CELSO
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 MOUNTAIN ROAD PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7808
Mailing Address - Country:US
Mailing Address - Phone:505-315-7397
Mailing Address - Fax:
Practice Address - Street 1:8001 MOUNTAIN ROAD PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7808
Practice Address - Country:US
Practice Address - Phone:505-315-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMCTB-2022-0114101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator