Healthcare Provider Details

I. General information

NPI: 1174883508
Provider Name (Legal Business Name): TIRZAH K ALVA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE
ALBUQUERQUE NM
87102-2611
US

IV. Provider business mailing address

PO BOX 20452
ALBUQUERQUE NM
87154-0452
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4530
  • Fax: 505-823-4538
Mailing address:
  • Phone: 505-823-4530
  • Fax: 505-823-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0149201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: