Healthcare Provider Details

I. General information

NPI: 1447124243
Provider Name (Legal Business Name): TESS KIM THERAPEUTICS MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MOUNTAIN RD NW
ALBUQUERQUE NM
87102-1855
US

IV. Provider business mailing address

4200 BROCKMONT AVE NE
ALBUQUERQUE NM
87108-1102
US

V. Phone/Fax

Practice location:
  • Phone: 808-772-3144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TESS KIM
Title or Position: OWNER
Credential: LPCC
Phone: 808-772-3144