Healthcare Provider Details

I. General information

NPI: 1104489269
Provider Name (Legal Business Name): BUBAR AND COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SAN PEDRO DR NE STE D
ALBUQUERQUE NM
87110-3331
US

IV. Provider business mailing address

7000 GRANGE AVE NW
ALBUQUERQUE NM
87120-3517
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-0098
  • Fax:
Mailing address:
  • Phone: 505-385-0098
  • Fax: 866-726-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHODA W BUBAR
Title or Position: PROVIDER
Credential: LPCC
Phone: 505-385-0098