Healthcare Provider Details

I. General information

NPI: 1275357162
Provider Name (Legal Business Name): HEART HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-1908
US

IV. Provider business mailing address

8001 AGUA FRIA CT NW
ALBUQUERQUE NM
87120-7055
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-0405
  • Fax:
Mailing address:
  • Phone: 505-929-2242
  • 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: AMANDA PLEASE SELECT MOE
Title or Position: OWNER
Credential: LPCC
Phone: 505-929-2242