Individual
MILES ONTIVEROS MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Mailing address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2026-0350
NM
Other
Enumeration date
05/11/2026
Last updated
05/11/2026
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