Healthcare Provider Details

I. General information

NPI: 1083063309
Provider Name (Legal Business Name): INTEGRATED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL STE 211
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

1012 MARQUEZ PL STE 211
SANTA FE NM
87505-1834
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-2832
  • Fax:
Mailing address:
  • Phone: 505-490-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0178651
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09424
License Number StateNM

VIII. Authorized Official

Name: REBECCA LEHNEN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW, LADAC
Phone: 505-490-2832