Healthcare Provider Details

I. General information

NPI: 1114780350
Provider Name (Legal Business Name): EMMA KATHLEEN KRUEGER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

IV. Provider business mailing address

4169 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-9770
  • Fax:
Mailing address:
  • Phone: 505-261-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0848
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: