Healthcare Provider Details

I. General information

NPI: 1891164919
Provider Name (Legal Business Name): COUNSELING AND PSYCHOTHERAPY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 TIJERAS AVE NW
ALBUQUERQUE NM
87102-3096
US

IV. Provider business mailing address

803 TIJERAS AVE NW
ALBUQUERQUE NM
87102-3096
US

V. Phone/Fax

Practice location:
  • Phone: 505-243-2223
  • Fax: 505-243-3576
Mailing address:
  • Phone: 505-243-2223
  • Fax: 505-243-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. KEN WELLS
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 505-243-2223