Healthcare Provider Details

I. General information

NPI: 1316613128
Provider Name (Legal Business Name): FORTIFIED MIND COUNSELING SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 LOUISIANA BLVD NE STE B
ALBUQUERQUE NM
87110-2734
US

IV. Provider business mailing address

9616 SUNDORO PL NW
ALBUQUERQUE NM
87120-2987
US

V. Phone/Fax

Practice location:
  • Phone: 505-494-5931
  • Fax: 505-508-2163
Mailing address:
  • Phone: 505-659-3067
  • 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: KAREN DENISE BARNES
Title or Position: MANAGING PARTNER
Credential:
Phone: 505-494-5931