Healthcare Provider Details

I. General information

NPI: 1649182486
Provider Name (Legal Business Name): ALYSSA LAURA ABREU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 9TH ST
LAS VEGAS NM
87701-3910
US

IV. Provider business mailing address

402 9TH ST
LAS VEGAS NM
87701-3910
US

V. Phone/Fax

Practice location:
  • Phone: 505-426-2668
  • Fax:
Mailing address:
  • Phone: 505-426-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberB-10007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: