Healthcare Provider Details

I. General information

NPI: 1942657663
Provider Name (Legal Business Name): TRACY VUNKANNON PARGIN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 MOUNTAIN ROAD PL NE
ALBUQUERQUE NM
87110-7808
US

IV. Provider business mailing address

PO BOX 6601
ALBUQUERQUE NM
87197-6601
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-7397
  • Fax: 505-460-8652
Mailing address:
  • Phone: 505-315-7397
  • Fax: 505-460-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCMH0184201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: