Healthcare Provider Details

I. General information

NPI: 1326814369
Provider Name (Legal Business Name): HEART SPACES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 SIMMS AVE SE
ALBUQUERQUE NM
87108-4374
US

IV. Provider business mailing address

4013 SIMMS AVE SE
ALBUQUERQUE NM
87108-4374
US

V. Phone/Fax

Practice location:
  • Phone: 505-372-4142
  • Fax:
Mailing address:
  • Phone: 505-372-4142
  • 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: MRS. EMILIA ANDERSON AUR
Title or Position: OWNER
Credential: LPCC
Phone: 505-372-4142