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General NPI Number Information
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NPI Number | 1518485812
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Entity Type | Organization
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Legal Business Name | WINDSONG COUNSELING & CONSULTATION, LLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 9426 INDIAN SCHOOL RD NE STE 1
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2887
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Country | US
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Telephone | 505-345-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 208 SANGRE DE CRISTO
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City | CEDAR CREST
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State | NM
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Zip | 87008-9525
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Country | US
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Telephone | 347-837-2501
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARISSA A MALEY
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Credential | PH.D.
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Telephone | 347-837-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 1381
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 1381
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1381
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1381
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License Number State | NM
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