Healthcare Provider Details

I. General information

NPI: 1871256347
Provider Name (Legal Business Name): COYOTE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE SUITE 305
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

PO BOX 53044
ALBUQUERQUE NM
87153-3044
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-5992
  • Fax: 505-554-3435
Mailing address:
  • Phone: 505-717-5992
  • Fax: 505-554-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN YOUNG
Title or Position: OWNER
Credential: LPCC
Phone: 505-717-5992