Healthcare Provider Details

I. General information

NPI: 1275601858
Provider Name (Legal Business Name): LINDA HENRY ORELL MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND DR SE SUITE B
ALBUQUERQUE NM
87108-2778
US

IV. Provider business mailing address

301 GRACELAND DR SE SUITE B
ALBUQUERQUE NM
87108-2778
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-2504
  • Fax: 505-898-1801
Mailing address:
  • Phone: 505-615-2504
  • Fax: 505-898-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNM1600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: