Healthcare Provider Details

I. General information

NPI: 1174276372
Provider Name (Legal Business Name): LIFEPATH COUNSELING & THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADEIRA DR NE STE 220
ALBUQUERQUE NM
87108-1538
US

IV. Provider business mailing address

120 MADEIRA DR NE STE 220
ALBUQUERQUE NM
87108-1538
US

V. Phone/Fax

Practice location:
  • Phone: 360-849-1760
  • Fax: 866-892-3005
Mailing address:
  • Phone: 360-849-1760
  • Fax: 866-892-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOLLY MILTON
Title or Position: OWNER
Credential:
Phone: 360-849-1760