Healthcare Provider Details

I. General information

NPI: 1407375371
Provider Name (Legal Business Name): INGELA ALTA ONSTAD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ANDERSON AVE SE
ALBUQUERQUE NM
87108-4306
US

IV. Provider business mailing address

3939 ANDERSON AVE SE
ALBUQUERQUE NM
87108-4306
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-6232
  • Fax:
Mailing address:
  • Phone: 505-670-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0767
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: