Healthcare Provider Details

I. General information

NPI: 1942668629
Provider Name (Legal Business Name): NILES HEWLETT LPCC, LCMHC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW STE G252
ALBUQUERQUE NM
87104-2050
US

IV. Provider business mailing address

1 LLANITO RD
BERNALILLO NM
87004-9701
US

V. Phone/Fax

Practice location:
  • Phone: 505-702-8112
  • Fax:
Mailing address:
  • Phone: 505-895-1914
  • 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:
Title or Position:
Credential:
Phone: