MEDICARE: MS. PATRICIA MARI HENNESSEY LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	17647	TX
2	101YS0200X	School Counselor
3	101YP2500X	Professional Counselor	87571	NM

General Provider Information

NPI Number	:	1114916566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA MARI HENNESSEY LPCC

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:	SUITE 2222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:	505-272-8060

Provider Business Practice Location Address
First Line	:	2600 MARBLE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2058
Country	:	US
Telephone Number	:	505-272-2190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	06/08/2023

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