Provider Demographics
NPI:1760525349
Name:BEUTTEL, MICHELE HELENE (LBSW,LMSW,LISW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:HELENE
Last Name:BEUTTEL
Suffix:
Gender:F
Credentials:LBSW,LMSW,LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26372
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6372
Mailing Address - Country:US
Mailing Address - Phone:575-770-1703
Mailing Address - Fax:
Practice Address - Street 1:2113 ALHAMBRA AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1601
Practice Address - Country:US
Practice Address - Phone:575-770-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-068101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42685222Medicaid