Melissa L Fagan, LMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0184771 Issued in NM

Practice address

3901 Louisiana Blvd NE Ste C
Albuquerque, NM 87110-1448

Phone

(505) 888-1686

Fax

(505) 888-1683

NPI assigned

Oct 17, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bosque Mental Health Associates, Inc.

  • Counselor
  • Albuquerque, NM
  • NPI 1982733226
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492732800000",
    "number": "1235210543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 LOUISIANA BLVD NE STE C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101448",
            "telephone_number": "505-888-1686",
            "fax_number": "505-888-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 LOUISIANA BLVD NE STE C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101448",
            "telephone_number": "505-888-1686",
            "fax_number": "505-888-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "MELISSA",
        "middle_name": "L",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2017-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "0184771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64079775",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Face Forward Therapy LLC
• Cheyenne Fachan
• Janet Fackrell
• Laura Fadraga
• Jodi Fagan, LCSW
• Brian W Fahey, PH.D.
• Dena Fahlquist, AUD
• Jennifer Hope Failla, LPCC
• Eva Dennie Fain, RN CDE
• Vivian Lashawn Fain, LPCC

• Professional Counselor in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Professional Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.