Healthcare Provider Details

I. General information

NPI: 1437868320
Provider Name (Legal Business Name): EDWARD SEAMUS GENTZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SEAMUS GENTZ LPCC

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 CANDELARIA RD NW
ALBUQUERQUE NM
87107-2767
US

IV. Provider business mailing address

1605 LOS LUCEROS RD NW
ALBUQUERQUE NM
87104-2667
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-3244
  • Fax:
Mailing address:
  • Phone: 505-615-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0355
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: