=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588165666
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZEN AWAKENINGS COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2018
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2929 COORS BLVD NW STE 309C
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-261-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7308 NIQUEL PL NW
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87120-1578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-261-1703
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | JANET L SCHROEDER
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 505-261-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0191101
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------