Provider Demographics
NPI:1740597772
Name:NOGALES, TRISHA XAVIERA (LPCC)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:XAVIERA
Last Name:NOGALES
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:XAVIERA
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4502
Mailing Address - Country:US
Mailing Address - Phone:505-212-7405
Mailing Address - Fax:505-877-3533
Practice Address - Street 1:1710 EL CENTRO FAMILIAR BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105
Practice Address - Country:US
Practice Address - Phone:505-212-7405
Practice Address - Fax:505-877-3533
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161831101YM0800X
171M00000X
NM0137691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator