Healthcare Provider Details

I. General information

NPI: 1306757331
Provider Name (Legal Business Name): ANDREW ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 MENAUL BLVD NE STE 100
ALBUQUERQUE NM
87112-2567
US

IV. Provider business mailing address

12400 MENAUL BLVD NE STE 100
ALBUQUERQUE NM
87112-2567
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-1978
  • Fax: 575-339-2780
Mailing address:
  • Phone: 505-933-1978
  • Fax: 575-339-2780

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:
Title or Position:
Credential:
Phone: