Healthcare Provider Details

I. General information

NPI: 1194513127
Provider Name (Legal Business Name): COLETTE LYRAE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 GIBSON BLVD SE RM 106
ALBUQUERQUE NM
87106-5041
US

IV. Provider business mailing address

1501 GIBSON BLVD SE RM 106
ALBUQUERQUE NM
87106-5041
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-265-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.011687
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20230328
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: