Individual
MS. TARA KATHRYN THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
8338 COMANCHE RD NE STE B, ALBUQUERQUE, NM 87110-2357
(505) 323-3665
(505) 323-1038
Mailing address
8338 COMANCHE RD NE STE B, ALBUQUERQUE, NM 87110-2357
(505) 323-3665
(505) 323-1038
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0100161
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10006701
LOVELACE
—
05
—
34083260
—
NM
01
—
76804
PRESBYTERIAN
—
01
—
NM00JB93
BCBS
NM
Enumeration date
08/21/2007
Last updated
08/21/2007
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