Healthcare Provider Details

I. General information

NPI: 1982299368
Provider Name (Legal Business Name): KIERSTEN FIGURSKI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CAMINO DEL MEDIO
SAN CRISTOBAL NM
87564
US

IV. Provider business mailing address

PO BOX 133
SAN CRISTOBAL NM
87564-0133
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5680
  • Fax:
Mailing address:
  • Phone: 575-770-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIERSTEN FIGURSKI
Title or Position: OWNER
Credential: LPCC
Phone: 575-770-5680