Healthcare Provider Details

I. General information

NPI: 1326626581
Provider Name (Legal Business Name): MEGHAN PADILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 11/19/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 LOS ARBOLES AVE NE
ALBUQUERQUE NM
87107-1943
US

IV. Provider business mailing address

3301 LOS ARBOLES AVE NE
ALBUQUERQUE NM
87107-1943
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7092
  • Fax:
Mailing address:
  • Phone: 505-800-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0736
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: