1821305244 NPI number — ARBOR COUNSELING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821305244 NPI number — ARBOR COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARBOR COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821305244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 SAN PEDRO DR NE
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-414-7721
Provider Business Mailing Address Fax Number:
678-426-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 SAN PEDRO DR NE
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-414-7721
Provider Business Practice Location Address Fax Number:
678-426-6620
Provider Enumeration Date:
09/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
ROXANNE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
505-301-1899

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0125261 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80427855 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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