Healthcare Provider Details

I. General information

NPI: 1629235593
Provider Name (Legal Business Name): NM FAMILY EDUCATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 ALVARADO DR NE SUITE 7
ALBUQUERQUE NM
87110-5161
US

IV. Provider business mailing address

1923 ALVARADO DR NE SUITE 7
ALBUQUERQUE NM
87110-5161
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-7845
  • Fax: 866-611-4627
Mailing address:
  • Phone: 505-717-7845
  • Fax: 866-611-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: J MAXWELL JACQUES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-717-7845