Healthcare Provider Details

I. General information

NPI: 1477262038
Provider Name (Legal Business Name): MICHELLE JARAMILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 03/03/2025
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

IV. Provider business mailing address

8205 SPAIN RD NE STE 106
ALBUQUERQUE NM
87109-3155
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-0300
  • Fax: 505-856-7946
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberSWB-2024-0563
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: