Healthcare Provider Details

I. General information

NPI: 1679330138
Provider Name (Legal Business Name): NEW EXPERIENCES COUNSELING AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/31/2026
Certification Date: 08/01/2024
Deactivation Date: 01/06/2026
Reactivation Date: 03/31/2026

III. Provider practice location address

2727 SAN PEDRO DR NE STE 110
ALBUQUERQUE NM
87110-3373
US

IV. Provider business mailing address

5105 ROYENE AVE NE
ALBUQUERQUE NM
87110-5841
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-7765
  • Fax:
Mailing address:
  • Phone: 505-670-7765
  • 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: TIFFANY WYNN
Title or Position: OWNER
Credential: OHD
Phone: 505-670-7765