Healthcare Provider Details

I. General information

NPI: 1033750435
Provider Name (Legal Business Name): TRUE COLOR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 THAXTON AVE SE
ALBUQUERQUE NM
87106-1628
US

IV. Provider business mailing address

3505 VAIL AVE SE APT C
ALBUQUERQUE NM
87106-1666
US

V. Phone/Fax

Practice location:
  • Phone: 828-712-8278
  • Fax:
Mailing address:
  • Phone: 828-712-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNE HARRIETTE BUGEL
Title or Position: MANAGER-MANAGED/OWNER
Credential: LCSW
Phone: 828-712-8278