Healthcare Provider Details

I. General information

NPI: 1417438110
Provider Name (Legal Business Name): DEHLEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SPAIN RD NE, BUILDING E
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

11000 SPAIN RD NE, BUILDING E
ALBUQUERQUE NM
87111
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-3282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0182531
License Number StateNM

VIII. Authorized Official

Name: DEBORAH EHLEN
Title or Position: REGISTERED AGENT
Credential:
Phone: 505-273-3282