Healthcare Provider Details

I. General information

NPI: 1255148979
Provider Name (Legal Business Name): ALBUQUERQUE FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

IV. Provider business mailing address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0104
  • Fax:
Mailing address:
  • Phone:
  • 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: WENDY YVETTE ORTIZ
Title or Position: INTERN
Credential:
Phone: 505-315-2310