Healthcare Provider Details

I. General information

NPI: 1366216277
Provider Name (Legal Business Name): COUNSELING COLLECTIVE NM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE STE B203
ALBUQUERQUE NM
87109-1202
US

IV. Provider business mailing address

9500 PERALTA RD NE
ALBUQUERQUE NM
87109-6358
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-3352
  • Fax:
Mailing address:
  • Phone: 505-480-3352
  • 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: STEPHANIE L TURNER
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LPCC
Phone: 505-480-3352