Healthcare Provider Details

I. General information

NPI: 1235107137
Provider Name (Legal Business Name): SYLMA FINE M.A., MFT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

PO BOX 25601
ALBUQUERQUE NM
87125-0601
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-6381
  • Fax:
Mailing address:
  • Phone: 505-553-6381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC 41633
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC 41633
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0133601
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0133601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: