Provider Demographics
NPI:1982928123
Name:MITCHELL, MELISSA BUNNELL (MSW, LISW)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BUNNELL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:LYNN
Other - Last Name:BUNNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LISW
Mailing Address - Street 1:23 BOSQUE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-2231
Mailing Address - Country:US
Mailing Address - Phone:505-920-8868
Mailing Address - Fax:505-466-1029
Practice Address - Street 1:914 BACA ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-0972
Practice Address - Country:US
Practice Address - Phone:505-920-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-32961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical