Healthcare Provider Details

I. General information

NPI: 1407426141
Provider Name (Legal Business Name): FOUR CIRCLES HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD. NE SUITE A2
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

6035 CYONUS AVENUE NW
ALBUQUERQUE NM
87114
US

V. Phone/Fax

Practice location:
  • Phone: 505-315-8213
  • Fax:
Mailing address:
  • Phone: 505-315-8213
  • 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: MS. FREIDA A. TRUJILLO
Title or Position: CLINICAL MH COUNSELOR/OWNER
Credential: MA, LPCC, BHC
Phone: 505-315-8213