Healthcare Provider Details

I. General information

NPI: 1124422852
Provider Name (Legal Business Name): MICHELLE ANGELICA TAFOYA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 VENICE AVE NE STE A
ALBUQUERQUE NM
87113-2337
US

IV. Provider business mailing address

625 SILVER AVE SW
ALBUQUERQUE NM
87102-3123
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-6367
  • Fax:
Mailing address:
  • Phone: 505-238-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0192261
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: