Provider Demographics
NPI:1144523200
Name:BANGO, GISELLE DEL CARMEN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:DEL CARMEN
Last Name:BANGO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 SHAVANO PEAK DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6792
Mailing Address - Country:US
Mailing Address - Phone:828-301-8171
Mailing Address - Fax:828-333-5584
Practice Address - Street 1:2554 SHAVANO PEAK DR NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-6792
Practice Address - Country:US
Practice Address - Phone:828-301-8171
Practice Address - Fax:828-333-5584
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0212061101YA0400X
NC1409106H00000X
NMCMF0201891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78850517Medicaid
NC6105307Medicaid