Healthcare Provider Details

I. General information

NPI: 1699656298
Provider Name (Legal Business Name): MARGARET BALTZER LSAA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

IV. Provider business mailing address

912 1ST ST NW
ALBUQUERQUE NM
87102-2355
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-9777
  • Fax:
Mailing address:
  • Phone: 505-224-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0610
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: