Provider Demographics
NPI:1699262428
Name:MELINDA G. CARDENAS
Entity type:Organization
Organization Name:MELINDA G. CARDENAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:GAUMER
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LPAT, ATR-BC
Authorized Official - Phone:505-414-0275
Mailing Address - Street 1:115 PUEBLO LUNA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6727
Mailing Address - Country:US
Mailing Address - Phone:505-414-0275
Mailing Address - Fax:
Practice Address - Street 1:707 BROADWAY BLVD NE STE 103
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2300
Practice Address - Country:US
Practice Address - Phone:505-414-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM183441251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health