Healthcare Provider Details

I. General information

NPI: 1841907094
Provider Name (Legal Business Name): PHOENIX COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 MONTGOMERY PKWY NE
ALBUQUERQUE NM
87111-3876
US

IV. Provider business mailing address

10401 MONTGOMERY PKWY NE STE 1-K
ALBUQUERQUE NM
87111-3876
US

V. Phone/Fax

Practice location:
  • Phone: 505-227-7623
  • Fax:
Mailing address:
  • Phone: 505-227-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. LOAN PHAN
Title or Position: LICENCED PROFESS CLINICAL COUNSELOR
Credential: PHD
Phone: 505-227-7623