Healthcare Provider Details

I. General information

NPI: 1962960443
Provider Name (Legal Business Name): YIN YANG COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 CAMINO DEL NORTE NE
ALBUQUERQUE NM
87123-1709
US

IV. Provider business mailing address

13320 CAMINO DEL NORTE NE
ALBUQUERQUE NM
87123-1709
US

V. Phone/Fax

Practice location:
  • Phone: 773-213-4182
  • Fax:
Mailing address:
  • Phone: 773-213-4182
  • Fax:

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: KERRI PAYNE
Title or Position: OWNER
Credential:
Phone: 773-213-4182