Healthcare Provider Details

I. General information

NPI: 1861960387
Provider Name (Legal Business Name): LA MARIPOSA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 102D
ALBUQUERQUE NM
87120-1224
US

IV. Provider business mailing address

7115 WESTON PL NW
ALBUQUERQUE NM
87114-3672
US

V. Phone/Fax

Practice location:
  • Phone: 505-663-7781
  • Fax:
Mailing address:
  • Phone: 505-393-9752
  • 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: VANESSA TORRES
Title or Position: OWNER
Credential: LCSW
Phone: 505-393-9752