Provider Demographics
NPI:1336900679
Name:ANGEL, AIMELDA MARIEL (LCMHC)
Entity Type:Individual
Prefix:
First Name:AIMELDA MARIEL
Middle Name:
Last Name:ANGEL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 TULA DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3145
Mailing Address - Country:US
Mailing Address - Phone:505-504-9445
Mailing Address - Fax:
Practice Address - Street 1:1207 GOLF COURSE RD SE STE A
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5213
Practice Address - Country:US
Practice Address - Phone:505-994-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty