Healthcare Provider Details

I. General information

NPI: 1306539069
Provider Name (Legal Business Name): CHELSEA GABRIELA MORAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

2605 NORMENT RD SW
ALBUQUERQUE NM
87105-7021
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4468
  • Fax:
Mailing address:
  • Phone: 818-429-7436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0436
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: