Healthcare Provider Details

I. General information

NPI: 1245563154
Provider Name (Legal Business Name): NANCY LOUISE HITE CPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 MANZANO ST NE
ALBUQUERQUE NM
87110-6302
US

IV. Provider business mailing address

622 MANZANO ST NE
ALBUQUERQUE NM
87110-6302
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4044
  • Fax: 505-925-4055
Mailing address:
  • Phone: 505-925-4044
  • Fax: 505-925-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number172Y00000X
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: