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General NPI Number Information
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NPI Number | 1972057909
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Entity Type | Organization
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Legal Business Name | COUNSELING WITH LOVE, 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 | 4253 MONTGOMERY BLVD NE SUITE 230
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1106
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Country | US
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Telephone | 505-550-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 4253 MONTGOMERY BLVD NE SUITE 230
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1106
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Country | US
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Telephone | 505-550-7352
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Fax |
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Authorized Official
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Title or Position | LISENCED CLINICAL MENTAL HEALTH COU
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Name | JESSICA MADRID
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Credential | M.A., LPCC
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Telephone | 505-550-7352
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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 | 0182891
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License Number State | NM
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