Provider Demographics
NPI:1881136703
Name:MANSARAM, MILA (LMHC)
Entity type:Individual
Prefix:MISS
First Name:MILA
Middle Name:
Last Name:MANSARAM
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:PO BOX 13387
Mailing Address - Street 2:ALBUQUERQUE BEHAVIORAL HEALTH LLC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87192
Mailing Address - Country:US
Mailing Address - Phone:505-830-6500
Mailing Address - Fax:505-830-6527
Practice Address - Street 1:8200 MOUNTAIN RD NE
Practice Address - Street 2:SUITE 106
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7843
Practice Address - Country:US
Practice Address - Phone:505-830-6500
Practice Address - Fax:505-830-6527
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0185011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health