Healthcare Provider Details

I. General information

NPI: 1023567591
Provider Name (Legal Business Name): SHANNON R FIGUEROA LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC06 3870 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSCO6 3870 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-1771
US

V. Phone/Fax

Practice location:
  • Phone: 505-277-3136
  • Fax:
Mailing address:
  • Phone: 505-277-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0186461
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: