Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shantell Divinity Moreno

Individual provider Behavior Technician · NPI 1174011407

Shantell Divinity Moreno is a Mental Health Counselor in Albuquerque, New Mexico. Qualified in 2021, 5 years ago. Works from 2 locations. Licensed in New Mexico.

Years since qualifying
5
Licensed in
NM
In the registry since
2018
Specialties on file
2
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Practice location Address checks out

1101 Medical Arts Ave NE
Albuquerque, NM 87102
Phone: (505) 933-4639
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 41521 W 11 Mile Rd, Novi, MI 48375-1803 — (248) 299-0030

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence CTB20250475 (NM)
Behavior Technician Taxonomy 106S00000X

Record details

NPI number1174011407
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 23, 2018
Last updated in NPPESJuly 30, 2025
Certification dateJuly 30, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Albuquerque