Healthcare Provider Details

I. General information

NPI: 1720226590
Provider Name (Legal Business Name): NEW HORIZONS COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2009
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6741
US

IV. Provider business mailing address

6424 AVENIDA SEVILLE NW
ALBUQUERQUE NM
87114-3765
US

V. Phone/Fax

Practice location:
  • Phone: 505-560-2804
  • Fax:
Mailing address:
  • Phone: 575-317-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberM-06906
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number0119561
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TATIA O HARRIS-LIPE
Title or Position: OWNER/CEO
Credential: LCSW, ACCTS
Phone: 575-317-8717