Provider Demographics
NPI:1174986707
Name:EMMANUEL CHRISTIAN COUNSELING & FULL LIFE MINISTRIES, LLC
Entity type:Organization
Organization Name:EMMANUEL CHRISTIAN COUNSELING & FULL LIFE MINISTRIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-930-8184
Mailing Address - Street 1:100 SUN AVE NE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4659
Mailing Address - Country:US
Mailing Address - Phone:505-835-6764
Mailing Address - Fax:505-835-6501
Practice Address - Street 1:100 SUN AVE NE
Practice Address - Street 2:SUITE 650
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4659
Practice Address - Country:US
Practice Address - Phone:505-835-6764
Practice Address - Fax:505-835-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health