Healthcare Provider Details

I. General information

NPI: 1194425629
Provider Name (Legal Business Name): CEREBRAL SOLUTIONS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 COORS BLVD NW STE H8
ALBUQUERQUE NM
87114-4048
US

IV. Provider business mailing address

10813 BUCKBOARD ST NW
ALBUQUERQUE NM
87114-5464
US

V. Phone/Fax

Practice location:
  • Phone: 505-900-5084
  • Fax:
Mailing address:
  • Phone: 505-818-9762
  • Fax:

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: LORA SMALLEY
Title or Position: OWNER
Credential: LMFT
Phone: 505-900-5084