Healthcare Provider Details

I. General information

NPI: 1275450843
Provider Name (Legal Business Name): TAMIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 INDIAN SCHOOL RD NE STE 200
ALBUQUERQUE NM
87110-4082
US

IV. Provider business mailing address

816 WRIGHT ST APT 2
CLOVIS NM
88101-3479
US

V. Phone/Fax

Practice location:
  • Phone: 505-548-9023
  • Fax:
Mailing address:
  • Phone: 575-607-8142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0524
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: