Healthcare Provider Details

I. General information

NPI: 1750703799
Provider Name (Legal Business Name): WELLNESS WORKS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 MONTANO RD NW SUITE A
ALBUQUERQUE NM
87120-2170
US

IV. Provider business mailing address

8205 SPAIN RD NE SUITE 106
ALBUQUERQUE NM
87109-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-2259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0160651
License Number StateNM

VIII. Authorized Official

Name: KAREN COBB
Title or Position: LPCC
Credential: LPCC
Phone: 505-239-2259