Healthcare Provider Details

I. General information

NPI: 1821305244
Provider Name (Legal Business Name): ARBOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SAN PEDRO DR NE SUITE 214
ALBUQUERQUE NM
87110-4122
US

IV. Provider business mailing address

2501 SAN PEDRO DR NE SUITE 214
ALBUQUERQUE NM
87110-4122
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-7721
  • Fax: 678-426-6620
Mailing address:
  • Phone: 505-414-7721
  • Fax: 678-426-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0125261
License Number StateNM

VIII. Authorized Official

Name: ROXANNE D PRATT
Title or Position: CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-301-1899