Healthcare Provider Details

I. General information

NPI: 1700620259
Provider Name (Legal Business Name): BAILEY REIMHOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YALE BLVD NE
ALBUQUERQUE NM
87106-3825
US

IV. Provider business mailing address

4601 MONTANO RD NW APT 223
ALBUQUERQUE NM
87120-2467
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0407
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: