MEDICARE: A GREENLEAF COUNSELING, INC

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	101YP2500X	Professional Counselor	0123631	NM

General Provider Information

NPI Number	:	1275963555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A GREENLEAF COUNSELING, INC

Provider Business Mailing Address
First Line	:	1280 SUNSET RD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-3726
Country	:	US
Telephone Number	:	505-514-8630
Fax Number	:	505-452-3448

Provider Business Practice Location Address
First Line	:	2626 CENTRAL AVE SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-1616
Country	:	US
Telephone Number	:	505-514-8630
Fax Number	:	595-452-3448

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MS. PATRICIA ALLAIRE
Credential	:
Telephone Number	:	505-514-8630

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

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