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General NPI Number Information
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NPI Number | 1144523200
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Entity Type | Individual
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Provider Name | GISELLE DEL CARMEN BANGO LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 2554 SHAVANO PEAK DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-6792
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Country | US
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Telephone | 828-301-8171
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Fax | 828-333-5584
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Provider Business Mailing Address
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Address Line | 2554 SHAVANO PEAK DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-6792
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Country | US
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Telephone | 828-301-8171
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Fax | 828-333-5584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAD0212061
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1409
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | CMF0201891
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License Number State | NM
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