Healthcare Provider Details

I. General information

NPI: 1801933577
Provider Name (Legal Business Name): MORIAH CHARLENE MACCLEOD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SOMBRA DEL MONTE RD STE 119
PLACITAS NM
87043-8743
US

IV. Provider business mailing address

145 CALLE DEL PRESIDENTE UNIT 1128
BERNALILLO NM
87004-2046
US

V. Phone/Fax

Practice location:
  • Phone: 505-364-4688
  • Fax:
Mailing address:
  • Phone: 505-364-4688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1637
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: