Provider Demographics
NPI:1477093326
Name:RE, AMINA (LMHC)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:
Last Name:RE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 OLD PECOS TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4759
Mailing Address - Country:US
Mailing Address - Phone:505-820-0477
Mailing Address - Fax:
Practice Address - Street 1:1800 OLD PECOS TRL STE A
Practice Address - Street 2:STE A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4759
Practice Address - Country:US
Practice Address - Phone:505-820-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0183831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health