Provider Demographics
NPI:1538283858
Name:MERAZ, ISABELLA RAQUEL (LMHC)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:RAQUEL
Last Name:MERAZ
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 1:1001 YALE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3825
Mailing Address - Country:US
Mailing Address - Phone:505-506-0315
Mailing Address - Fax:505-272-1940
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-7601
Practice Address - Country:US
Practice Address - Phone:505-506-0315
Practice Address - Fax:505-272-1940
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66920787Medicaid