Healthcare Provider Details

I. General information

NPI: 1376704262
Provider Name (Legal Business Name): KERSTEN COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 LOMAS BLVD NE SUITE 204
ALBUQUERQUE NM
87112-5463
US

IV. Provider business mailing address

10701 LOMAS BLVD NE SUITE 204
ALBUQUERQUE NM
87112-5463
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-9255
  • Fax: 505-298-2900
Mailing address:
  • Phone: 505-550-9255
  • Fax: 505-298-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05378
License Number StateNM

VIII. Authorized Official

Name: MS. SUZANNE H. KERSTEN
Title or Position: OWNER
Credential: LISW
Phone: 505-550-9255