Healthcare Provider Details

I. General information

NPI: 1548835366
Provider Name (Legal Business Name): INTEGRATIVE COUNSELING & PSYCHOTHERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321-B CANDELARIA ROAD NE SUITE #403
ALBUQUERQUE NM
87107
US

IV. Provider business mailing address

3321-B CANDELARIA ROAD NE SUITE #403
ALBUQUERQUE NM
87107
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1379
  • Fax:
Mailing address:
  • Phone: 505-219-1379
  • 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: HELEN TAFOYA
Title or Position: OWNER
Credential: PHD. LPCC
Phone: 505-219-1379