Healthcare Provider Details

I. General information

NPI: 1386381002
Provider Name (Legal Business Name): WELLNESS MATTERS COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 05/14/2022
Certification Date: 05/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 CASA VISTOSA CT NW
ALBUQUERQUE NM
87120-2903
US

IV. Provider business mailing address

8601 CASA VISTOSA CT NW
ALBUQUERQUE NM
87120-2903
US

V. Phone/Fax

Practice location:
  • Phone: 505-362-5762
  • Fax:
Mailing address:
  • Phone: 505-362-5762
  • 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: REBECA GURROLA
Title or Position: COFOUNDER
Credential: LPCC
Phone: 505-362-5762