MEDICARE: AURORA COUNSELING & MENTAL HEALTH

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	1041C0700X	Clinical Social Worker	I-06342	NM

General Provider Information

NPI Number	:	1265853303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA COUNSELING & MENTAL HEALTH

Provider Business Mailing Address
First Line	:	1233 STUTZ DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-6232
Country	:	US
Telephone Number	:	505-639-8141
Fax Number	:

Provider Business Practice Location Address
First Line	:	1233 STUTZ DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-6232
Country	:	US
Telephone Number	:	505-246-6910
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. KATHYRN POPE COCHRAN
Credential	:	LISW
Telephone Number	:	505-639-8141

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	03/24/2014

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