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General NPI Number Information
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NPI Number | 1740734755
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Entity Type | Organization
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Legal Business Name | COMPASSIONATE COUNSELING PSYCHOTHERAPY SERVICE 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 | 5800 MCLEOD RD NE SUITE E
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2454
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Country | US
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Telephone | 505-688-9221
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 JAMAICA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2839
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Country | US
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Telephone | 505-688-9221
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | R MICHAEL WESTBAY
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Credential | LCSW
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Telephone | 505-688-9221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2575
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C-2163
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License Number State | NM
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