Healthcare Provider Details

I. General information

NPI: 1790121275
Provider Name (Legal Business Name): INSIGHT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 GUADALAJARA AVE NE
ALBUQUERQUE NM
87111-1719
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE PMB# 148
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-710-0812
  • Fax:
Mailing address:
  • Phone: 505-710-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0111751
License Number StateNM

VIII. Authorized Official

Name: NAN DENICE WEE
Title or Position: OWNER
Credential: LPCC
Phone: 505-710-0812