Healthcare Provider Details

I. General information

NPI: 1386279297
Provider Name (Legal Business Name): COUNSELING ALBUQUERQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 ALAMEDA BLVD NE STE A
ALBUQUERQUE NM
87113-1362
US

IV. Provider business mailing address

PO BOX 37431
ALBUQUERQUE NM
87176-7431
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-2846
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AUBREY KOPCZYNSKI
Title or Position: OWNER
Credential: LPCC, MA
Phone: 505-228-2846