Provider Demographics
NPI:1376704262
Name:KERSTEN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:KERSTEN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:KERSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-550-9255
Mailing Address - Street 1:10701 LOMAS BLVD NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5463
Mailing Address - Country:US
Mailing Address - Phone:505-550-9255
Mailing Address - Fax:505-298-4900
Practice Address - Street 1:10701 LOMAS BLVD NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5463
Practice Address - Country:US
Practice Address - Phone:505-550-9255
Practice Address - Fax:505-298-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-053781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM804636OtherMAGELLAN