Healthcare Provider Details

I. General information

NPI: 1215762208
Provider Name (Legal Business Name): TRI PEAK BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2024
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE STE B101
ALBUQUERQUE NM
87109-1206
US

IV. Provider business mailing address

6213 LOFTUS AVE NE
ALBUQUERQUE NM
87109-2715
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-3054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MATTHIAS A DIETRICH
Title or Position: OWNER
Credential: LPCC
Phone: 505-920-3054