MEDICARE: NEW HORIZONS COUNSELING SERVICES, 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	252Y00000X	Early Intervention Provider Agency	M-06906	NM
2	252Y00000X	Early Intervention Provider Agency	0119561	NM
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1720226590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZONS COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	6424 AVENIDA SEVILLE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3765
Country	:	US
Telephone Number	:	575-317-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 MONTGOMERY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6741
Country	:	US
Telephone Number	:	505-560-2804
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TATIA O HARRIS-LIPE
Credential	:	LCSW, ACCTS
Telephone Number	:	575-317-8717

Provider Enumeration Date	:	02/01/2009
Last Update Date	:	09/15/2022

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