Healthcare Provider Details

I. General information

NPI: 1710574546
Provider Name (Legal Business Name): ANA MARIA BISONO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 4TH ST NW STE 102
ALBUQUERQUE NM
87102-2104
US

IV. Provider business mailing address

500 4TH ST NW STE 102
ALBUQUERQUE NM
87102-2104
US

V. Phone/Fax

Practice location:
  • Phone: 505-810-2098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20230540
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: