Healthcare Provider Details

I. General information

NPI: 1073221818
Provider Name (Legal Business Name): WHOLEHEART COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8108 SIGUARD CT NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

8100 WYOMING BLVD NE SUITE M4 #848
ALBUQUERQUE NM
87113
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-3446
  • Fax:
Mailing address:
  • Phone: 505-977-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAUREN MARY MARTELL
Title or Position: THERAPIST/OWNER
Credential: LPCC
Phone: 505-977-3446