Healthcare Provider Details

I. General information

NPI: 1427170430
Provider Name (Legal Business Name): DIANA MONROE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CARLISLE BLVD NE SUITE 225
ALBUQUERQUE NM
87110-1600
US

IV. Provider business mailing address

3200 CARLISLE BLVD NE SUITE 225
ALBUQUERQUE NM
87110-1600
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-6059
  • Fax: 505-830-6091
Mailing address:
  • Phone: 505-830-6059
  • Fax: 505-830-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0095971
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: