Healthcare Provider Details

I. General information

NPI: 1699052142
Provider Name (Legal Business Name): MICHELLE TE VELDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 COUNTRY CLUB RD STE B
SANTA TERESA NM
88008-9413
US

IV. Provider business mailing address

4590 TRADE ST UNIT 4419
JOHNSTOWN CO
80534-6634
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-1881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: