Healthcare Provider Details

I. General information

NPI: 1699812073
Provider Name (Legal Business Name): CHARLENE E PYSKOTY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MOUNTAIN RD NW STE 202
ALBUQUERQUE NM
87102-1855
US

IV. Provider business mailing address

2 GASTONEAU COUNTRY LN
TIJERAS NM
87059-7469
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-1821
  • Fax:
Mailing address:
  • Phone: 505-306-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0108971
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: