MEDICARE: MRS. YVONNE ROACHO MOGHADAM LMHC/LSAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CMH0175791	NM
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0143141	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740610955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE ROACHO MOGHADAM LMHC/LSAA

Provider Business Mailing Address
First Line	:	3809 ATRISCO DR NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-4902
Country	:	US
Telephone Number	:	505-932-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 ATRISCO DR NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-4902
Country	:	US
Telephone Number	:	505-932-8979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	12/23/2025

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