Provider Demographics
NPI:1144596289
Name:PAHOS, MICHAEL L (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:PAHOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 WREN WALK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6108
Mailing Address - Country:US
Mailing Address - Phone:505-362-4536
Mailing Address - Fax:505-212-0976
Practice Address - Street 1:5800 MCLEOD RD NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2467
Practice Address - Country:US
Practice Address - Phone:505-362-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-085651041C0700X
NMM-078511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical