Healthcare Provider Details

I. General information

NPI: 1336816164
Provider Name (Legal Business Name): ANGELA SHERIDAN COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12836 LOMAS BLVD NE STE C
ALBUQUERQUE NM
87112-6200
US

IV. Provider business mailing address

12836 LOMAS BLVD NE STE C
ALBUQUERQUE NM
87112-6200
US

V. Phone/Fax

Practice location:
  • Phone: 505-595-7149
  • Fax:
Mailing address:
  • Phone: 505-595-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0156
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCTB-2026-0156
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: