Healthcare Provider Details

I. General information

NPI: 1447061270
Provider Name (Legal Business Name): HIROKO MINAMI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4304 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4811
US

IV. Provider business mailing address

320 HARVARD DR SE APT 99
ALBUQUERQUE NM
87106-3557
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-7561
  • Fax: 505-214-4570
Mailing address:
  • Phone: 505-303-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0630
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: