Healthcare Provider Details

I. General information

NPI: 1326321969
Provider Name (Legal Business Name): NANCY NORDYKE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 PROSPECT PL NE
ALBUQUERQUE NM
87110-4332
US

IV. Provider business mailing address

2341 GENERAL BRADLEY ST NE
ALBUQUERQUE NM
87112-1158
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-9329
  • Fax: 505-888-0477
Mailing address:
  • Phone: 505-220-9329
  • Fax: 505-888-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2963
License Number StateNM

VIII. Authorized Official

Name: MS. NANCY NORDYKE ISBELL
Title or Position: SOLE MEMBER/OWNER
Credential: MA, LPCC, NCC
Phone: 505-220-9329