Healthcare Provider Details

I. General information

NPI: 1316598220
Provider Name (Legal Business Name): NANCY KAY STAFFORD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10555 MONTGOMERY BLVD NE # 2
ALBUQUERQUE NM
87111-3857
US

IV. Provider business mailing address

12117 MANITOBA NE
ALBUQUERQUE NM
87111-2751
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-7946
  • Fax:
Mailing address:
  • Phone: 505-681-4083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0206681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: