Healthcare Provider Details

I. General information

NPI: 1427423177
Provider Name (Legal Business Name): MICHELLE L HARMON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-3853
US

IV. Provider business mailing address

9400 EAGLE ROCK AVE NE
ALBUQUERQUE NM
87122-3853
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-6868
  • Fax:
Mailing address:
  • Phone: 505-259-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0172911
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0196561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: