Healthcare Provider Details

I. General information

NPI: 1720596273
Provider Name (Legal Business Name): MICHELLE MAREK LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7843
US

IV. Provider business mailing address

2905 CLAREMONT PL NE
ALBUQUERQUE NM
87110-3242
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-6500
  • Fax:
Mailing address:
  • Phone: 505-720-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: