Healthcare Provider Details

I. General information

NPI: 1609234590
Provider Name (Legal Business Name): LA LUZ COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 TENNYSON ST NE APT 6302
ALBUQUERQUE NM
87111-8161
US

IV. Provider business mailing address

6601 TENNYSON ST NE APT 6302
ALBUQUERQUE NM
87111-8161
US

V. Phone/Fax

Practice location:
  • Phone: 505-226-0654
  • Fax:
Mailing address:
  • Phone: 505-226-0654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW L SEREFINE
Title or Position: OWNER
Credential: MS, LMFT
Phone: 505-226-0654