Healthcare Provider Details

I. General information

NPI: 1255636585
Provider Name (Legal Business Name): SHERWIN KEITH PRICE LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

2441 CABEZON BLVD SE
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2573
  • Fax:
Mailing address:
  • Phone: 505-717-1155
  • Fax: 505-717-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0164601
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCMH0184991
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0184991
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: