Healthcare Provider Details

I. General information

NPI: 1609107861
Provider Name (Legal Business Name): ANTHONY PAUL SMARRELLA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
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

PO BOX 1175
TIJERAS NM
87059-1175
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-5488
  • Fax: 505-286-1653
Mailing address:
  • Phone: 505-228-5488
  • Fax: 505-286-1653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0083641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: