Healthcare Provider Details

I. General information

NPI: 1972057909
Provider Name (Legal Business Name): COUNSELING WITH LOVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY BLVD NE SUITE 230
ALBUQUERQUE NM
87109-1106
US

IV. Provider business mailing address

4253 MONTGOMERY BLVD NE SUITE 230
ALBUQUERQUE NM
87109-1106
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-7352
  • Fax:
Mailing address:
  • Phone: 505-550-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0182891
License Number StateNM

VIII. Authorized Official

Name: JESSICA MADRID
Title or Position: LISENCED CLINICAL MENTAL HEALTH COU
Credential: M.A., LPCC
Phone: 505-550-7352