Healthcare Provider Details

I. General information

NPI: 1063149649
Provider Name (Legal Business Name): WILDFLOWER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY BLVD NE STE G130
ALBUQUERQUE NM
87109-1106
US

IV. Provider business mailing address

729 LANDMAN PL NE
ALBUQUERQUE NM
87123-1673
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-1283
  • Fax: 505-207-6167
Mailing address:
  • Phone: 505-401-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLA TAFOYA-TORREZ
Title or Position: OWNER
Credential: LPCC
Phone: 505-401-6630