Provider Demographics
NPI:1821305244
Name:ARBOR COUNSELING LLC
Entity Type:Organization
Organization Name:ARBOR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-301-1899
Mailing Address - Street 1:2501 SAN PEDRO DR NE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4122
Mailing Address - Country:US
Mailing Address - Phone:505-414-7721
Mailing Address - Fax:678-426-6620
Practice Address - Street 1:2501 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 214
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4122
Practice Address - Country:US
Practice Address - Phone:505-414-7721
Practice Address - Fax:678-426-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0125261101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80427855Medicaid