ROBERT KEVIN HENNELLY LPPC LLC NPI 1073103552

NPI Information

NPI: 1073103552
Provider Name: ROBERT KEVIN HENNELLY, LPPC, LLC
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
2205 MIGUEL CHAVEZ RD STE F
SANTA FE, NM
ZIP 87505
Phone: (505) 629-7108
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ROBERT KEVIN HENNELLY, LPPC, LLC is a mental health (including community mental health center) clinic center in Santa Fe, NM. ROBERT KEVIN HENNELLY, LPPC, LLC NPI is 1073103552. The provider is registered as an organization entity type.

The provider's business location address is:

2205 MIGUEL CHAVEZ RD STE F
SANTA FE, NM
ZIP 87505-111
Phone: (505) 629-7108

The provider's authorized official is Robert K Hennelly .
The authorized official title is Psychotherapist and has the following contact phone number (505) 629-7108.

The enumeration date for this NPI number is 1/19/2021 and was last updated on 1/19/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	25087827	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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