Healthcare Provider Details

I. General information

NPI: 1902340607
Provider Name (Legal Business Name): A NEW PATH COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10417 SAN JACINTO AVE NE
ALBUQUERQUE NM
87112-5341
US

IV. Provider business mailing address

10417 SAN JACINTO AVE NE
ALBUQUERQUE NM
87112-5341
US

V. Phone/Fax

Practice location:
  • Phone: 505-235-4393
  • Fax:
Mailing address:
  • Phone:
  • 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: ARCHIE GRINE
Title or Position: OWNER
Credential:
Phone: 505-235-4393