MEDICARE: COMPREHENSIVE COUNSELING 505 LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326637273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE COUNSELING 505 LLC

Provider Business Mailing Address
First Line	:	3901 GEORGIA ST NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1359
Country	:	US
Telephone Number	:	505-980-3832
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 GEORGIA ST NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1359
Country	:	US
Telephone Number	:	505-980-3832
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TROY LUNA
Credential	:	LPCC
Telephone Number	:	505-980-3832

Provider Enumeration Date	:	01/14/2021
Last Update Date	:	11/08/2022

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