Healthcare Provider Details

I. General information

NPI: 1285196121
Provider Name (Legal Business Name): TLC-THE LEARNING CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CHELWOOD PARK BLVD NE
ALBUQUERQUE NM
87111-5413
US

IV. Provider business mailing address

3505 CHELWOOD PARK BLVD NE
ALBUQUERQUE NM
87111-5413
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-8706
  • 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: THOMAS CORDOVA
Title or Position: OWNER
Credential:
Phone: 505-270-8706