Healthcare Provider Details

I. General information

NPI: 1528162617
Provider Name (Legal Business Name): RIO GRANDE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAS LOMAS RD NE STE 4
ALBUQUERQUE NM
87102-2634
US

IV. Provider business mailing address

10320 MALAGUENA LN NE
ALBUQUERQUE NM
87111-1721
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-8700
  • Fax:
Mailing address:
  • Phone: 505-712-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05540
License Number StateNM

VIII. Authorized Official

Name: MRS. CAROLYN MONTOYA
Title or Position: THERAPIST
Credential: LMSW
Phone: 505-246-8700