Healthcare Provider Details

I. General information

NPI: 1255605713
Provider Name (Legal Business Name): ESSENTIAL SELF COUNSELING, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 TRINITY DR STE C
LOS ALAMOS NM
87544-2226
US

IV. Provider business mailing address

62 GRAND CANYON DR
WHITE ROCK NM
87547-3400
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-0010
  • Fax:
Mailing address:
  • Phone: 505-412-0010
  • Fax: 505-451-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA K. HILL
Title or Position: PRACTICE ADMINISTRATOR
Credential: LMFT
Phone: 505-412-2555