Healthcare Provider Details

I. General information

NPI: 1699242313
Provider Name (Legal Business Name): SKELTON COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 PATTON DR
GALLUP NM
87301-4784
US

IV. Provider business mailing address

2505 KIRBY ST NE
ALBUQUERQUE NM
87112-1831
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-5171
  • Fax:
Mailing address:
  • Phone: 505-506-5171
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE SKELTON
Title or Position: OWNER
Credential: LCSW
Phone: 505-506-5171