MEDICARE: HENNESSEY COUNSELING AND CONSULTATION

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1265246813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENNESSEY COUNSELING AND CONSULTATION

Provider Business Mailing Address
First Line	:	5728 CARMEN RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3844
Country	:	US
Telephone Number	:	505-259-7388
Fax Number	:

Provider Business Practice Location Address
First Line	:	5728 CARMEN RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3844
Country	:	US
Telephone Number	:	505-259-7388
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PATRICIA MARI HENNESSEY
Credential	:	LPCC
Telephone Number	:	505-259-7388

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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