Individual
MISTY TABISULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
320 OSUNA RD NE STE H4, ALBUQUERQUE, NM 87107-5955
(505) 345-2778
Mailing address
320 OSUNA RD NE STE H4, ALBUQUERQUE, NM 87107-5955
(505) 345-2778
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CCMH0201901
NM
101Y00000X
Counselor
LPC008435
GA
106H00000X
Marriage & Family Therapist
Primary
CMF0197861
NM
106H00000X
Marriage & Family Therapist
MFT001348
GA
Other
Enumeration date
08/23/2018
Last updated
09/29/2020
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