Healthcare Provider Details

I. General information

NPI: 1255984365
Provider Name (Legal Business Name): EMILY L PLANTE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE STE O
ALBUQUERQUE NM
87109-2468
US

IV. Provider business mailing address

11827 ELVIN AVE NE
ALBUQUERQUE NM
87112-3475
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-4305
  • Fax:
Mailing address:
  • Phone: 505-514-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0203731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: