Healthcare Provider Details

I. General information

NPI: 1861051930
Provider Name (Legal Business Name): MICHELLE ZAINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date: 03/17/2020
Reactivation Date: 08/03/2021

III. Provider practice location address

2469 CORRALES RD STE E
CORRALES NM
87048-9148
US

IV. Provider business mailing address

2612 TEXAS ST NE
ALBUQUERQUE NM
87110-4684
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax:
Mailing address:
  • Phone: 505-974-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTCTL0218271
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: