Healthcare Provider Details

I. General information

NPI: 1700377868
Provider Name (Legal Business Name): JULIA HERRERA GARDNER LPCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

IV. Provider business mailing address

306 WASHINGTON ST SE
ALBUQUERQUE NM
87108-2735
US

V. Phone/Fax

Practice location:
  • Phone: 505-859-9559
  • Fax:
Mailing address:
  • Phone: 505-859-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0951
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: