Provider Demographics
NPI:1881193050
Name:TUBB, KRISTIN RENEE (BA, MA, LADAC, LPCC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:TUBB
Suffix:
Gender:F
Credentials:BA, MA, LADAC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11204 SAN JACINTO AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5523
Mailing Address - Country:US
Mailing Address - Phone:505-514-2500
Mailing Address - Fax:
Practice Address - Street 1:5916 ANAHEIM AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1894
Practice Address - Country:US
Practice Address - Phone:505-291-6314
Practice Address - Fax:505-275-0296
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0224881101YM0800X
NMCTB-2024-0525101YP2500X
NMCAD0203661101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15858898Medicaid