Healthcare Provider Details

I. General information

NPI: 1467309690
Provider Name (Legal Business Name): ENCHANTEDJOURNEYTHERAPEUTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 KALAHARI LN
LAS CRUCES NM
88011
US

IV. Provider business mailing address

2260 E LOHMAN AVE # 1166
LAS CRUCES NM
88001-8490
US

V. Phone/Fax

Practice location:
  • Phone: 575-952-0652
  • Fax:
Mailing address:
  • Phone: 575-952-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIELLA MICELI
Title or Position: MANAGING MEMBER/OWNER
Credential: PH.D.
Phone: 575-952-0652