Healthcare Provider Details

I. General information

NPI: 1598366056
Provider Name (Legal Business Name): WHOLE PERSON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321B CANDELARIA RD NE STE 310
ALBUQUERQUE NM
87107-1908
US

IV. Provider business mailing address

PO BOX 40354
ALBUQUERQUE NM
87196-0354
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-8440
  • Fax: 505-554-3435
Mailing address:
  • Phone: 505-699-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE IMISLUND-CLARKE
Title or Position: OWNER
Credential: LPCC
Phone: 505-699-8440