Healthcare Provider Details

I. General information

NPI: 1720656911
Provider Name (Legal Business Name): KENDRA KOZEL MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4905
US

IV. Provider business mailing address

1803 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4905
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-9911
  • Fax: 505-254-9911
Mailing address:
  • Phone: 505-842-9911
  • Fax: 505-254-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0217821
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: