Healthcare Provider Details

I. General information

NPI: 1740734755
Provider Name (Legal Business Name): COMPASSIONATE COUNSELING PSYCHOTHERAPY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MCLEOD RD NE SUITE E
ALBUQUERQUE NM
87109-2454
US

IV. Provider business mailing address

4607 JAMAICA DR NE
ALBUQUERQUE NM
87111-2839
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-9221
  • Fax:
Mailing address:
  • Phone: 505-688-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2575
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-2163
License Number StateNM

VIII. Authorized Official

Name: R MICHAEL WESTBAY
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 505-688-9221