Healthcare Provider Details

I. General information

NPI: 1881193050
Provider Name (Legal Business Name): KRISTIN RENEE TUBB BA, MA, LADAC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 ANAHEIM AVE NE STE A
ALBUQUERQUE NM
87113-1894
US

IV. Provider business mailing address

11204 SAN JACINTO AVE NE
ALBUQUERQUE NM
87112-5523
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-6314
  • Fax: 505-275-0296
Mailing address:
  • Phone: 505-514-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0224881
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0525
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0203661
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: