Basic Information
| Provider Information | |||||||||
| NPI: | 1770736134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISELY | ||||||||
| FirstName: | TANGELA | ||||||||
| MiddleName: | ZOE | ||||||||
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| Credential: | M.C.L.M.H.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1349 | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S. HUDSON | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2008 | ||||||||
| LastUpdateDate: | 07/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | T-0117601 | NM | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | 0118721 | NM | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.