Healthcare Provider Details

I. General information

NPI: 1265853303
Provider Name (Legal Business Name): AURORA COUNSELING & MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 STUTZ DR NE
ALBUQUERQUE NM
87112-6232
US

IV. Provider business mailing address

1233 STUTZ DR NE
ALBUQUERQUE NM
87112-6232
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-6910
  • Fax:
Mailing address:
  • Phone: 505-639-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06342
License Number StateNM

VIII. Authorized Official

Name: MS. KATHYRN POPE COCHRAN
Title or Position: CEO
Credential: LISW
Phone: 505-639-8141