Provider Demographics
NPI:1861051930
Name:ZAINTZ, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ZAINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 TEXAS ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4684
Mailing Address - Country:US
Mailing Address - Phone:505-974-1849
Mailing Address - Fax:
Practice Address - Street 1:2469 CORRALES RD STE E
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-9148
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2021-10-18
Deactivation Date:2020-03-17
Deactivation Code:
Reactivation Date:2021-08-03
Provider Licenses
StateLicense IDTaxonomies
NMTCTL0218271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health