Healthcare Provider Details

I. General information

NPI: 1750428256
Provider Name (Legal Business Name): BW COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE SUITE 110
ALBUQUERQUE NM
87109-4474
US

IV. Provider business mailing address

4801 LANG AVE NE SUITE 110
ALBUQUERQUE NM
87109-4474
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-2541
  • Fax: 505-796-9601
Mailing address:
  • Phone: 505-798-2541
  • Fax: 505-796-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86331
License Number StateNM

VIII. Authorized Official

Name: BARBARA CALDWELL
Title or Position: OFFICE MANAGER
Credential: LPCC
Phone: 505-798-2541