Healthcare Provider Details

I. General information

NPI: 1851704670
Provider Name (Legal Business Name): BONNI AMSDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 AVENIDA LA RESOLANA NE
ALBUQUERQUE NM
87110-6103
US

IV. Provider business mailing address

4011 AVENIDA LA RESOLANA NE
ALBUQUERQUE NM
87110-6103
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-3621
  • Fax:
Mailing address:
  • Phone: 505-256-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0186421
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: