Healthcare Provider Details

I. General information

NPI: 1740610955
Provider Name (Legal Business Name): YVONNE ROACHO MOGHADAM LMHC/LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 ATRISCO DR NW STE A
ALBUQUERQUE NM
87120-4902
US

IV. Provider business mailing address

3809 ATRISCO DR NW STE A
ALBUQUERQUE NM
87120-4902
US

V. Phone/Fax

Practice location:
  • Phone: 505-932-8979
  • Fax:
Mailing address:
  • Phone: 505-932-8979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCMH0175791
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0143141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: