Healthcare Provider Details

I. General information

NPI: 1932312576
Provider Name (Legal Business Name): MICHELE MAE ANAYA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 GRIEGOS RD NW
ALBUQUERQUE NM
87107-3752
US

IV. Provider business mailing address

8604 ROBBY AVE SW
ALBUQUERQUE NM
87121-7943
US

V. Phone/Fax

Practice location:
  • Phone: 505-342-5479
  • Fax:
Mailing address:
  • Phone: 505-239-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0065252
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: