MEDICARE: A SAFE PLACE COUNSELING CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144061474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SAFE PLACE COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	1924 JUAN TABO BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3358
Country	:	US
Telephone Number	:	505-250-8010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 JUAN TABO BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-3358
Country	:	US
Telephone Number	:	505-250-8010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DENA MARIE LAINO
Credential	:	LPCC
Telephone Number	:	505-250-8010

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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