Healthcare Provider Details

I. General information

NPI: 1255674826
Provider Name (Legal Business Name): MRS. CATHRYN NOVELLA VIGIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 ANAHEIM AVE NE SUITE A
ALBUQUERQUE NM
87113-1887
US

IV. Provider business mailing address

5916 ANAHEIM AVE NE SUITE A
ALBUQUERQUE NM
87113-1887
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-6314
  • Fax: 505-275-0296
Mailing address:
  • Phone: 505-291-6314
  • Fax: 505-275-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0157291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: