Healthcare Provider Details

I. General information

NPI: 1386044774
Provider Name (Legal Business Name): AFFECTIVE THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 EUBANK BLVD NE SUITE B-1
ALBUQUERQUE NM
87111-3579
US

IV. Provider business mailing address

3736 EUBANK BLVD NE STE B1
ALBUQUERQUE NM
87111-3583
US

V. Phone/Fax

Practice location:
  • Phone: 505-469-0779
  • Fax: 888-506-2110
Mailing address:
  • Phone: 505-382-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0163911
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0168461
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAMIELYNN GONZALES
Title or Position: PRACTICE OWNER
Credential: DSW, LCSW-S
Phone: 505-382-1578