Healthcare Provider Details

I. General information

NPI: 1013972181
Provider Name (Legal Business Name): SHERRY COURTNEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHERRY CHANNEL LPCC

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 CARLISLE BLVD NE SUITE D
ALBUQUERQUE NM
87107-4829
US

IV. Provider business mailing address

4316 CARLISLE BLVD NE SUITE D
ALBUQUERQUE NM
87107-4829
US

V. Phone/Fax

Practice location:
  • Phone: 505-837-2100
  • Fax: 505-888-7943
Mailing address:
  • Phone: 505-837-2100
  • Fax: 505-888-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2813
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: