Healthcare Provider Details

I. General information

NPI: 1346361920
Provider Name (Legal Business Name): CAROLYNNE COLBY-SCHMELTZER M.A., L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 WYOMING BLVD NE STE 216
ALBUQUERQUE NM
87111-3289
US

IV. Provider business mailing address

10516 SIERRA BONITA AVE NE
ALBUQUERQUE NM
87111-3828
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-1717
  • Fax: 505-292-1081
Mailing address:
  • Phone: 505-238-1717
  • Fax: 505-292-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0110811
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: