Provider Demographics
NPI:1912390360
Name:WOLF, MICHELE PIMENTA (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:PIMENTA
Last Name:WOLF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:PIMENTA
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4258 CACTUS FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0822
Mailing Address - Country:US
Mailing Address - Phone:720-341-0856
Mailing Address - Fax:
Practice Address - Street 1:4730 BECKNER ROAD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-989-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0106001101YM0800X
COMT. 0016965225700000X
NMCMF0218401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist