Individual
MICAELA TAMARA MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7323 SIDEWINDER DR NE, ALBUQUERQUE, NM 87113-1300
(505) 350-7633
Mailing address
7323 SIDEWINDER DR NE, ALBUQUERQUE, NM 87113-1300
(505) 350-7633
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CBT-2024-0831
NM
Other
Enumeration date
12/03/2025
Last updated
12/03/2025
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