Healthcare Provider Details

I. General information

NPI: 1952845042
Provider Name (Legal Business Name): ESPECIALLY FOR FAMILIES THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE. 102-F
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

6533 ANCIENTS RD NW
ALBUQUERQUE NM
87114-6112
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-0797
  • Fax:
Mailing address:
  • Phone: 505-238-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3196
License Number StateNM

VIII. Authorized Official

Name: MS. PATRICIA DAVIS BACA
Title or Position: OWNER
Credential: LPCC
Phone: 505-238-0797