Healthcare Provider Details

I. General information

NPI: 1770736134
Provider Name (Legal Business Name): TANGELA ZOE ISELY M.C.L.M.H.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S. HUDSON
SILVER CITY NM
88061
US

IV. Provider business mailing address

PO BOX 1349
SILVER CITY NM
88062-1349
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4497
  • Fax: 575-534-1150
Mailing address:
  • Phone: 575-388-4497
  • Fax: 575-534-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number77632
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7165
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6900
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: