Healthcare Provider Details

I. General information

NPI: 1154602787
Provider Name (Legal Business Name): MICHELLE LD MCPEEK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE DEMKO LPCC

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

IV. Provider business mailing address

184 UNSER BLVD NE
RIO RANCHO NM
87124-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-896-0928
  • Fax:
Mailing address:
  • Phone: 505-896-0928
  • 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: