Healthcare Provider Details

I. General information

NPI: 1235943853
Provider Name (Legal Business Name): MICHELLE LEJUAN WEEKS COUNSELING INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO BLVD NE
RIO RANCHO NM
87124-1456
US

IV. Provider business mailing address

3115 ALLYSON WAY NE
RIO RANCHO NM
87144-1464
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1460
  • Fax:
Mailing address:
  • Phone: 602-799-5938
  • 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:
Title or Position:
Credential:
Phone: