Healthcare Provider Details

I. General information

NPI: 1265998843
Provider Name (Legal Business Name): DESERT WILLOW COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 SPAIN RD NE STE B
ALBUQUERQUE NM
87111-1898
US

IV. Provider business mailing address

11001 SPAIN RD NE STE B
ALBUQUERQUE NM
87111-1898
US

V. Phone/Fax

Practice location:
  • Phone: 505-264-0698
  • Fax: 505-269-8299
Mailing address:
  • Phone: 505-264-0698
  • Fax: 505-269-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY BRASHER
Title or Position: OWNER
Credential: LPCC
Phone: 505-264-0698