Organization
MIND HEART AND SOUL COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TYRA JEAN RUSSELL FOX LLPC (CLINICAL MENTAL HEALTH COUNSELOR)
(505) 220-5809
Entity
Organization
Contact information
Practice address
315 ALAMEDA BLVD NE STE A, ALBUQUERQUE, NM 87113-2155
(505) 220-5809
Mailing address
PO BOX 15454, RIO RANCHO, NM 87174-0454
(505) 220-5809
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56552564
—
NM
Enumeration date
01/14/2020
Last updated
01/14/2020
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