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General NPI Number Information
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NPI Number | 1952845042
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Entity Type | Organization
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Legal Business Name | ESPECIALLY FOR FAMILIES THERAPY
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 2929 COORS BLVD NW STE. 102-F
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-1173
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Country | US
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Telephone | 505-238-0797
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Fax |
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Provider Business Mailing Address
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Address Line | 6533 ANCIENTS RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-6112
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Country | US
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Telephone | 505-238-0797
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PATRICIA DAVIS BACA
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Credential | LPCC
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Telephone | 505-238-0797
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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 | 3196
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License Number State | NM
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