Healthcare Provider Details

I. General information

NPI: 1265901896
Provider Name (Legal Business Name): MARTHA FRIGGENS, LCSW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 CARLISLE BLVD NE STE 109
ALBUQUERQUE NM
87110-5661
US

IV. Provider business mailing address

1218 LOS ARBOLES AVE NW
ALBUQUERQUE NM
87107-1012
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-2852
  • Fax:
Mailing address:
  • Phone: 505-804-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARTHA ANNA FRIGGENS
Title or Position: PSYCHO THERAPIST
Credential: LCSW
Phone: 505-804-2852