Healthcare Provider Details

I. General information

NPI: 1386044774
Provider Name (Legal Business Name): HERNDON CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/06/2023
Certification Date: 08/26/2021
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: 888-506-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0163911
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0168461
License Number StateNM

VIII. Authorized Official

Name: JAMIE LYNN GONZALES
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 505-382-1578