Provider Demographics
NPI:1487310306
Name:JUBB, MELANIE LYN (CRC, MS)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:LYN
Last Name:JUBB
Suffix:
Gender:F
Credentials:CRC, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27258
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-7258
Mailing Address - Country:US
Mailing Address - Phone:505-764-8231
Mailing Address - Fax:505-248-1351
Practice Address - Street 1:1201 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1403
Practice Address - Country:US
Practice Address - Phone:505-764-8231
Practice Address - Fax:505-248-1351
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator