Sandia Counseling Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SANDIA COUNSELING CENTER LLC

Practice address

8416 Sonoma Valley Rd NE
Albuquerque, NM 87122-2626

Phone

(505) 459-4647

NPI assigned

Sep 18, 2018

Last updated

Sep 18, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Shane, LPCCNPI 1750546990

Title

Ceo

Phone

(505) 459-4647

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Marie Shane, LPCC

  • Mental Health Counselor
  • Albuquerque, NM
  • NPI 1750546990
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537228800000",
    "number": "1568946358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8416 SONOMA VALLEY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871222626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8416 SONOMA VALLEY RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871222626",
            "telephone_number": "505-459-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDIA COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-18",
        "last_updated": "2018-09-18",
        "status": "A",
        "authorized_official_last_name": "SHANE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-459-4647",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3708741",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Mental Health Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.