Healthcare Provider Details

I. General information

NPI: 1104694207
Provider Name (Legal Business Name): SARAH BUNTING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2050
US

IV. Provider business mailing address

316 12TH ST SW
ALBUQUERQUE NM
87102-2812
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8112
  • Fax:
Mailing address:
  • Phone: 208-310-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0534
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: