Healthcare Provider Details

I. General information

NPI: 1891784328
Provider Name (Legal Business Name): LINDA ANN FALEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 MONTGOMERY BLVD NE SUITE B
ALBUQUERQUE NM
87109-1178
US

IV. Provider business mailing address

335 51ST ST NW
ALBUQUERQUE NM
87105-1707
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4464
  • Fax: 505-884-4464
Mailing address:
  • Phone: 505-884-4464
  • Fax: 505-884-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 4488
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: