Healthcare Provider Details

I. General information

NPI: 1407982002
Provider Name (Legal Business Name): CONFLICT MANAGEMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7805
US

IV. Provider business mailing address

7920 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7805
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-9411
  • Fax: 505-292-1428
Mailing address:
  • Phone: 505-884-9411
  • Fax: 505-292-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0045047
License Number StateNM

VIII. Authorized Official

Name: KERIN K GROVES
Title or Position: PRESIDENT
Credential: LPCC
Phone: 505-884-9411