Healthcare Provider Details

I. General information

NPI: 1144658204
Provider Name (Legal Business Name): SARAH PENN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 LOUISIANA BLVD NE STE 210
ALBUQUERQUE NM
87110-3569
US

IV. Provider business mailing address

2900 LOUISIANA BLVD NE STE 210
ALBUQUERQUE NM
87110-3569
US

V. Phone/Fax

Practice location:
  • Phone: 505-304-9431
  • Fax:
Mailing address:
  • Phone: 505-304-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0168731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: