Healthcare Provider Details

I. General information

NPI: 1376694125
Provider Name (Legal Business Name): KATHLEEN SAFKEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 JEFFERSON LN NE STE A
ALBUQUERQUE NM
87109-2116
US

IV. Provider business mailing address

527 WAGON TRAIN DR SE
ALBUQUERQUE NM
87123-4134
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1114
  • Fax: 505-884-3004
Mailing address:
  • Phone: 505-884-1114
  • Fax: 505-884-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0078351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: