Healthcare Provider Details

I. General information

NPI: 1215254909
Provider Name (Legal Business Name): COHERENT LEARNING SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10601 LOMAS BLVD NE STE 108
ALBUQUERQUE NM
87112-5462
US

IV. Provider business mailing address

10601 LOMAS BLVD NE STE 108
ALBUQUERQUE NM
87112-5462
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-9100
  • Fax: 505-856-9600
Mailing address:
  • Phone: 505-259-9100
  • Fax: 505-856-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0092471
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0122291
License Number StateNM

VIII. Authorized Official

Name: MR. CARLTON W LEWIS
Title or Position: MANAGER
Credential: M.A. LPCC LADAC
Phone: 505-259-9100