Healthcare Provider Details

I. General information

NPI: 1174872337
Provider Name (Legal Business Name): STELLA ASCHENBRENNER MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COORS BLVD NW # 112R
ALBUQUERQUE NM
87120-1292
US

IV. Provider business mailing address

3301 COORS BLVD NW # 112R
ALBUQUERQUE NM
87120-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-4701
  • Fax:
Mailing address:
  • Phone: 505-228-4701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0175141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: