Healthcare Provider Details

I. General information

NPI: 1104563956
Provider Name (Legal Business Name): DREAMLIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 VIA BOSQUE
SANTA FE NM
87506-4505
US

IV. Provider business mailing address

1933 SAN MATEO BLVD NE # 222
ALBUQUERQUE NM
87110-5146
US

V. Phone/Fax

Practice location:
  • Phone: 505-257-6868
  • Fax:
Mailing address:
  • Phone: 505-257-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN ALDRICH
Title or Position: CEO
Credential: LPCC
Phone: 505-257-6868