Individual
MISS AMY BETH STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1025 HERMOSA DR SE, ALBUQUERQUE, NM 87108-4312
(505) 237-0061
Mailing address
5741 OSUNA RD NE, APT.1015, ALBUQUERQUE, NM 87109-2567
(505) 227-0730
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-0144551
NM
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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