MEDICARE: ALBUQUERQUE GUIDANCE CENTER

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	101YM0800X	Mental Health Counselor	FA0098824	NM

General Provider Information

NPI Number	:	1427467547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBUQUERQUE GUIDANCE CENTER

Provider Business Mailing Address
First Line	:	2741 INDIAN SCHOOL RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2653
Country	:	US
Telephone Number	:	505-750-8866
Fax Number	:	505-444-8368

Provider Business Practice Location Address
First Line	:	601 LOVEJOY RD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-3849
Country	:	US
Telephone Number	:	505-750-8866
Fax Number	:	707-444-8368

Authorized Official
Title or Position	:	CEO/CLINICAL DIRECTOR
Name	:	CHARMAINE D LOPEZ
Credential	:	LPCC
Telephone Number	:	505-750-8866

Provider Enumeration Date	:	08/04/2014
Last Update Date	:	12/12/2017

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