Healthcare Provider Details

I. General information

NPI: 1194642066
Provider Name (Legal Business Name): HEAL THYSELF COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 WYOMING BLVD NE STE D5
ALBUQUERQUE NM
87109-3981
US

IV. Provider business mailing address

7007 WYOMING BLVD NE STE D5
ALBUQUERQUE NM
87109-3981
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-3303
  • Fax: 505-510-5100
Mailing address:
  • Phone: 505-298-3303
  • Fax: 505-510-5100

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: JAMIE LYNNE DOUGLAS
Title or Position: OWNER
Credential: LMHC, NCC
Phone: 505-314-4343