Healthcare Provider Details

I. General information

NPI: 1205168176
Provider Name (Legal Business Name): GEORGE CHIHA LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BRIDGE BLVD SW STE A
ALBUQUERQUE NM
87105-3765
US

IV. Provider business mailing address

PO BOX 28051
SANTA FE NM
87592-8051
US

V. Phone/Fax

Practice location:
  • Phone: 505-452-2975
  • Fax: 505-277-0139
Mailing address:
  • Phone: 972-971-1536
  • Fax: 505-724-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0095871
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10545
License Number StateTX

VIII. Authorized Official

Name: MR. GEORGE CHIHA
Title or Position: OWNER
Credential: LCSW
Phone: 972-971-1536