Healthcare Provider Details

I. General information

NPI: 1265903835
Provider Name (Legal Business Name): PACHA COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COORS BLVD NW UNIT R180
ALBUQUERQUE NM
87120-1292
US

IV. Provider business mailing address

3301 COORS BLVD NW UNIT R180
ALBUQUERQUE NM
87120-1292
US

V. Phone/Fax

Practice location:
  • Phone: 505-319-0792
  • 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: JENNY MULL
Title or Position: OWNER
Credential:
Phone: 505-319-0792