Healthcare Provider Details

I. General information

NPI: 1235481201
Provider Name (Legal Business Name): JOURNEYS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GOLD AVE SE
ALBUQUERQUE NM
87102-3430
US

IV. Provider business mailing address

111 GOLD AVE SE
ALBUQUERQUE NM
87102-3430
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-7541
  • Fax:
Mailing address:
  • Phone: 505-715-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0136091
License Number StateNM

VIII. Authorized Official

Name: ALICE L OTERO-ARMIJO
Title or Position: CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-715-7541