Healthcare Provider Details

I. General information

NPI: 1649164989
Provider Name (Legal Business Name): KATHLEEN MARGARET EDWARDS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10513 2ND ST NW
ALBUQUERQUE NM
87114-2403
US

IV. Provider business mailing address

9112 ORLANDO PL NE
ALBUQUERQUE NM
87111-3334
US

V. Phone/Fax

Practice location:
  • Phone: 505-803-8722
  • Fax:
Mailing address:
  • Phone: 505-293-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0341
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: