Healthcare Provider Details

I. General information

NPI: 1336900679
Provider Name (Legal Business Name): AIMELDA MARIEL ANGEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4035
US

IV. Provider business mailing address

PO BOX 12455
ALBUQUERQUE NM
87195-0455
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-7296
  • Fax:
Mailing address:
  • Phone: 505-312-7296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCBT-2024-0771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: