Healthcare Provider Details

I. General information

NPI: 1245943885
Provider Name (Legal Business Name): THE THERAPY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 LOUISIANA BLVD NE STE 208
ALBUQUERQUE NM
87110-7027
US

IV. Provider business mailing address

1717 LOUISIANA BLVD NE STE 208
ALBUQUERQUE NM
87110-7027
US

V. Phone/Fax

Practice location:
  • Phone: 800-292-4453
  • Fax:
Mailing address:
  • Phone: 800-292-4453
  • 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: MS. VONITANNA HARRISON
Title or Position: OWNER
Credential:
Phone: 800-292-4453