MEDICARE: FIREWEED THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1700736816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIREWEED THERAPY LLC

Provider Business Mailing Address
First Line	:	2501 RIO GRANDE BLVD NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 RIO GRANDE BLVD NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-3233
Country	:	US
Telephone Number	:	206-603-6500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT LUCAS PEISER
Credential	:
Telephone Number	:	206-603-6500

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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Directions to “FIREWEED THERAPY LLC ” Practice Location

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