Organization
ROBERT KEVIN HENNELLY, LPPC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT K HENNELLY LPPC (PSYCHOTHERAPIST)
(505) 629-7108
Entity
Organization
Contact information
Practice address
2205 MIGUEL CHAVEZ RD STE F, SANTA FE, NM 87505-1111
(505) 629-7108
Mailing address
2916 CALLE DERECHA, SANTA FE, NM 87505-6530
(505) 629-7108
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25087827
—
NM
Enumeration date
01/19/2021
Last updated
01/19/2021
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