Healthcare Provider Details

I. General information

NPI: 1346652120
Provider Name (Legal Business Name): INNER GUIDANCE LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-0061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number59172
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberM-08424
License Number StateNM

VIII. Authorized Official

Name: MICHELE COLEMAN
Title or Position: FOUNDER / CEO
Credential:
Phone: 505-237-0061