Healthcare Provider Details

I. General information

NPI: 1134968597
Provider Name (Legal Business Name): BUKOLA GBOTEMI BABATUNDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES MSC09-5030
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2101 E HARVARD AVE APT 207
DENVER CO
80210-5237
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2237
  • Fax:
Mailing address:
  • Phone: 720-736-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: