Individual
KELLY CHISHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
8500 MENAUL BLVD NE STE B455, ALBUQUERQUE, NM 87112-2287
(505) 974-0104
Mailing address
8500 MENAUL BLVD NE STE B455, ALBUQUERQUE, NM 87112-2287
(505) 974-0104
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0103091
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NM600403
—
NM
Enumeration date
05/01/2007
Last updated
03/17/2018
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