Healthcare Provider Details

I. General information

NPI: 1669673083
Provider Name (Legal Business Name): FEHRUNISSA M WILLETT LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 LOUISIANA BLVD NE SUITE 102
ALBUQUERQUE NM
87110-7001
US

IV. Provider business mailing address

2 CABEZON RD
PLACITAS NM
87043-9200
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-1903
  • Fax:
Mailing address:
  • Phone: 505-268-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0093361
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: