Healthcare Provider Details

I. General information

NPI: 1225259088
Provider Name (Legal Business Name): VANESSA LYNN HAYE-PORTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VANESSA LYNN HAYE LPCC

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE SUITE 2222
ALBUQUERQUE NM
87106-4375
US

IV. Provider business mailing address

933 BRADBURY DR SE
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3120
  • Fax: 505-272-8060
Mailing address:
  • Phone: 505-272-3120
  • Fax: 505-272-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 0078051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: