Organization
LIBERATEABQ, LLC
Active
Other names
LiberateABQ
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT THOMAS CLARK LPCC (OWNER)
(505) 596-0614
Entity
Organization
Contact information
Practice address
609 GOLD AVE SW STE 1F, ALBUQUERQUE, NM 87102-3119
(505) 758-7200
Mailing address
609 GOLD AVE SW STE 1F, ALBUQUERQUE, NM 87102-3119
(505) 758-7200
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04123751
—
NM
Enumeration date
02/19/2022
Last updated
09/06/2023
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