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General NPI Number Information
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NPI Number | 1700766045
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Entity Type | Organization
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Legal Business Name | VITALITY MIND HEALTH LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 500 MARQUETTE AVE NW STE 1200
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-5312
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Country | US
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Telephone | 505-933-5121
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 CALLE AMORADA CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5354
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Country | US
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Telephone | 505-933-5121
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Fax |
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Authorized Official
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Title or Position | LPCC/OWNER
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Name | MS. TIFFANY DENISE TRUJILLO
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Credential | MA, LPCC, NCC
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Telephone | 505-800-8033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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