Healthcare Provider Details

I. General information

NPI: 1285192310
Provider Name (Legal Business Name): INTEGRATIVE ELEMENTS NM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE STE R
ALBUQUERQUE NM
87107-4544
US

IV. Provider business mailing address

PO BOX 36816
ALBUQUERQUE NM
87176-6816
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-5522
  • Fax:
Mailing address:
  • Phone: 505-226-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ESQUIBEL
Title or Position: CEO
Credential: LPCC
Phone: 505-226-5522