Healthcare Provider Details

I. General information

NPI: 1558996751
Provider Name (Legal Business Name): ANDREA TAYLOR LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 CENTRAL AVE SW
ALBUQUERQUE NM
87102-3008
US

IV. Provider business mailing address

718 CENTRAL AVE SW
ALBUQUERQUE NM
87102-3008
US

V. Phone/Fax

Practice location:
  • Phone: 505-453-4304
  • Fax:
Mailing address:
  • Phone: 505-453-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0446
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: