Healthcare Provider Details

I. General information

NPI: 1215293022
Provider Name (Legal Business Name): HEYMAN COUNSELING & PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 WYOMING BLVD NE BUILDING G
ALBUQUERQUE NM
87109-3932
US

IV. Provider business mailing address

6501 WYOMING BLVD NE BUILDING G
ALBUQUERQUE NM
87109-3932
US

V. Phone/Fax

Practice location:
  • Phone: 505-410-3355
  • Fax:
Mailing address:
  • Phone: 505-410-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0120851
License Number StateNM

VIII. Authorized Official

Name: MICHELE M HEYMAN
Title or Position: SOLE MBR/PROPRIETOR
Credential: MA LPCC
Phone: 505-410-3355