Healthcare Provider Details

I. General information

NPI: 1184246902
Provider Name (Legal Business Name): AVENIDAS NUEVAS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 CORNELL DR SE
ALBUQUERQUE NM
87106-5513
US

IV. Provider business mailing address

324 CORNELL DR SE
ALBUQUERQUE NM
87106-5513
US

V. Phone/Fax

Practice location:
  • Phone: 602-380-1750
  • Fax:
Mailing address:
  • Phone: 602-380-1750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ANTONIO F LOMELI
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LCSW
Phone: 602-380-1750