Provider Demographics
NPI:1518624964
Name:LOPEZ-SULLIVAN, MELISSA MARIE (CLC, DOULA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:LOPEZ-SULLIVAN
Suffix:
Gender:
Credentials:CLC, DOULA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:BRICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC, DOULA
Mailing Address - Street 1:4367 CALLE AMARILLA
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1823
Mailing Address - Country:US
Mailing Address - Phone:575-520-0795
Mailing Address - Fax:
Practice Address - Street 1:4367 CALLE AMARILLA
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1823
Practice Address - Country:US
Practice Address - Phone:575-520-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 172V00000X, 174H00000X, 374K00000X
NM174N00000X
NM0013-2025374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty