Healthcare Provider Details

I. General information

NPI: 1033905021
Provider Name (Legal Business Name): KATELYN CAHILLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN FORSTROM

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MOUNTAIN RD NW
ALBUQUERQUE NM
87104-1359
US

IV. Provider business mailing address

9516 GOLDEN ROD CIR SE
ALBUQUERQUE NM
87116-3203
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-4656
  • Fax:
Mailing address:
  • Phone: 973-664-7612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0223
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: