Healthcare Provider Details

I. General information

NPI: 1932503166
Provider Name (Legal Business Name): COUNSELING & PSYCHOTHERAPY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TIJERAS AVE NW
ALBUQUERQUE NM
87102-3096
US

IV. Provider business mailing address

PO BOX 7065
ALBUQUERQUE NM
87194-7065
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-3333
  • Fax:
Mailing address:
  • Phone: 505-328-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0619341
License Number StateNM

VIII. Authorized Official

Name: DR. KEN EDUARD WELLS
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 505-328-3764