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General NPI Number Information
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NPI Number | 1215481239
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Entity Type | Organization
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Legal Business Name | CAP INDIVIDUAL & FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 2404 ROZINANTE DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3081
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Country | US
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Telephone | 505-263-4159
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Fax |
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Provider Business Mailing Address
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Address Line | 2404 ROZINANTE DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-3081
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Country | US
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Telephone | 505-263-4159
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | CELINA T BACA
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Credential | LMHC
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Telephone | 505-263-4159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | T-0181961
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License Number State | NM
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