Healthcare Provider Details

I. General information

NPI: 1700114782
Provider Name (Legal Business Name): FEREIDOUN KAMALI LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2190
  • Fax: 505-272-3466
Mailing address:
  • Phone: 505-272-8350
  • Fax: 505-272-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0165001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: