Healthcare Provider Details

I. General information

NPI: 1093165052
Provider Name (Legal Business Name): JOYCELYNN MYCHELE CORDERO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BARBARA LOOP SE
RIO RANCHO NM
87124-1088
US

IV. Provider business mailing address

5316 SOONER TRL NW
ALBUQUERQUE NM
87120-2949
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-4408
  • Fax:
Mailing address:
  • Phone: 505-453-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0178151
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: