Healthcare Provider Details

I. General information

NPI: 1487001004
Provider Name (Legal Business Name): LILLIAN GORDON NYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

IV. Provider business mailing address

606 49TH ST NW
ALBUQUERQUE NM
87105-1624
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-6848
  • Fax:
Mailing address:
  • Phone: 505-385-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2023-1097
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: