Healthcare Provider Details

I. General information

NPI: 1700651726
Provider Name (Legal Business Name): CATHERINE WIEBE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

IV. Provider business mailing address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0104
  • Fax:
Mailing address:
  • Phone: 505-974-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0976
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: