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General NPI Number Information
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NPI Number | 1932503166
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Entity Type | Organization
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Legal Business Name | COUNSELING & PSYCHOTHERAPY INSTITUTE
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 803 TIJERAS AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3096
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Country | US
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Telephone | 505-243-3333
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7065
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City | ALBUQUERQUE
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State | NM
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Zip | 87194-7065
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Country | US
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Telephone | 505-328-3764
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KEN EDUARD WELLS
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Credential | PH.D.
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Telephone | 505-328-3764
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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 | T-0619341
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License Number State | NM
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