| A Vibrant Mind Counseling, Llc | |
|
2900 Louisiana Blvd Ne Ste 200d Albuquerque NM 87110-3589 | |
| (505) 397-4189 | |
| Not Available |
| Full Name | A Vibrant Mind Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2900 Louisiana Blvd Ne Ste 200d, Albuquerque, New Mexico |
| Authorized Official Name and Position | Nicole Hartson (OWNER/DIRECTOR) |
| Authorized Official Contact | 5053974189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Vibrant Mind Counseling, Llc 2900 Louisiana Blvd Ne Ste 200d Albuquerque NM 87110-3589 Ph: (505) 397-4189 | A Vibrant Mind Counseling, Llc 2900 Louisiana Blvd Ne Ste 200d Albuquerque NM 87110-3589 Ph: (505) 397-4189 |
| NPI Number | 1508519430 |
|---|---|
| Provider Enumeration Date | 01/31/2022 |
| Last Update Date | 06/13/2022 |
| Certification Date | 06/13/2022 |
| Medicare PECOS PAC ID | 7214373638 |
|---|---|
| Medicare Enrollment ID | O20240307003294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508519430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nicole M. Hartson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548408545 PECOS PAC ID: 8123464542 Enrollment ID: I20240307003643 |
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