Healthcare Provider Details

I. General information

NPI: 1548374002
Provider Name (Legal Business Name): LEN FOLLICK LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 CONSTITUTION AVE NE SUITE B
ALBUQUERQUE NM
87106-1238
US

IV. Provider business mailing address

520 14TH ST NW
ALBUQUERQUE NM
87104-1322
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-5227
  • Fax:
Mailing address:
  • Phone: 505-450-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3100
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: