Healthcare Provider Details

I. General information

NPI: 1245062041
Provider Name (Legal Business Name): DIVERSE VOICES THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 OSUNA RD NE APT H
ALBUQUERQUE NM
87109-2535
US

IV. Provider business mailing address

5908 OSUNA RD NE APT H
ALBUQUERQUE NM
87109-2535
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-5829
  • Fax:
Mailing address:
  • Phone: 505-979-0715
  • Fax:

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: BRANDON R JOPEK
Title or Position: OWNER
Credential: LPCC
Phone: 505-979-0715