Healthcare Provider Details

I. General information

NPI: 1811187289
Provider Name (Legal Business Name): SOUTHWEST FAMILY GUIDANCE CENTER & INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2403 SAN MATEO BLVD NE STE. S-14
ALBUQUERQUE NM
87110-4058
US

IV. Provider business mailing address

2403 SAN MATEO BLVD NE STE. S-14
ALBUQUERQUE NM
87110-4058
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-1871
  • Fax: 505-830-0040
Mailing address:
  • Phone: 505-830-1871
  • Fax: 505-830-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1243
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1243
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1243
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1243
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1243
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1243
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1243
License Number StateNM

VIII. Authorized Official

Name: DR. CRAIG L. PIERCE
Title or Position: PSYCHOTHERAPIST/CHIEF CLINICAL DIR.
Credential: PHD
Phone: 505-830-1871