Healthcare Provider Details

I. General information

NPI: 1750017562
Provider Name (Legal Business Name): CHRISTOPHER GUIDER MA, LMHC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SAN MATEO BLVD NE STE 100
ALBUQUERQUE NM
87110-3166
US

IV. Provider business mailing address

2800 SAN MATEO BLVD NE STE 100
ALBUQUERQUE NM
87110-3166
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-0146
  • Fax: 505-884-2004
Mailing address:
  • Phone: 505-884-0146
  • Fax: 505-884-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0304
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: