Healthcare Provider Details

I. General information

NPI: 1417189945
Provider Name (Legal Business Name): COUNSELING & PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 MILES RD SE
ALBUQUERQUE NM
87106-3224
US

IV. Provider business mailing address

2127 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2565
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-6602
  • Fax: 505-842-1503
Mailing address:
  • Phone: 505-948-6602
  • Fax: 505-842-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2595
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI04783
License Number StateNM

VIII. Authorized Official

Name: SARA H. MCGEE
Title or Position: CLINICAL SOCIAL WORKER
Credential: MA, MFA, ATR, MSW
Phone: 505-948-6602