Individual
MR. EDWARD THOMAS CHURCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
1330 SAN PEDRO DR NE, SUITE 201B, ALBUQUERQUE, NM 87110-6744
(505) 260-9912
Mailing address
4001 BLUE RIDGE PL NE, ALBUQUERQUE, NM 87111-4168
(505) 299-1634
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0085761
NM
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
0085761
NM
Other
Enumeration date
11/29/2006
Last updated
09/18/2013
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