Healthcare Provider Details

I. General information

NPI: 1962177006
Provider Name (Legal Business Name): MICHELLE A CHAVEZ VALENZUELA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE 14
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

6102 SUMMER RAY RD NW
ALBUQUERQUE NM
87120-6115
US

V. Phone/Fax

Practice location:
  • Phone: 505-518-5757
  • Fax: 505-461-6217
Mailing address:
  • Phone: 505-720-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0219361
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: