Healthcare Provider Details

I. General information

NPI: 1043607732
Provider Name (Legal Business Name): SMALL STEPS INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BROADWAY BLVD NE SUITE 103
ALBUQUERQUE NM
87102-2360
US

IV. Provider business mailing address

707 BROADWAY BLVD NE SUITE 103
ALBUQUERQUE NM
87102-2360
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-4639
  • Fax: 505-206-5002
Mailing address:
  • Phone: 505-933-4639
  • Fax: 505-206-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0109871
License Number StateNM

VIII. Authorized Official

Name: MS. COURTNEY LEWIS
Title or Position: DIRECTOR
Credential: LPCC
Phone: 505-933-4639