Healthcare Provider Details

I. General information

NPI: 1457199481
Provider Name (Legal Business Name): SAFE SPACE CHILD-PARENT COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 GULTON CT NE STE A
ALBUQUERQUE NM
87109-4407
US

IV. Provider business mailing address

6612 GULTON CT NE STE A
ALBUQUERQUE NM
87109-4407
US

V. Phone/Fax

Practice location:
  • Phone: 505-221-6045
  • Fax:
Mailing address:
  • Phone: 505-221-6045
  • 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: MICHELLE LISA MORTON
Title or Position: OWNER
Credential: LPCC
Phone: 505-221-6045