Healthcare Provider Details

I. General information

NPI: 1699426221
Provider Name (Legal Business Name): CORAZON HEALING HEARTS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

3301R COORS BLVD NW # 330
ALBUQUERQUE NM
87120-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-805-4307
  • Fax:
Mailing address:
  • Phone: 505-257-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VALERIE RODRIGUEZ
Title or Position: THERAPIST
Credential: LPCC
Phone: 505-805-4307