Healthcare Provider Details

I. General information

NPI: 1548037211
Provider Name (Legal Business Name): NEUROO COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 HOLLY AVE NE BLDG 4
ALBUQUERQUE NM
87122-2969
US

IV. Provider business mailing address

508 ARAGON ST SE
ALBUQUERQUE NM
87123-4505
US

V. Phone/Fax

Practice location:
  • Phone: 505-886-1381
  • Fax:
Mailing address:
  • Phone: 505-886-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER GEORGIEFF
Title or Position: OWNER/CLINICAL SUPERVISOR
Credential: LPCC
Phone: 505-886-1381