Healthcare Provider Details

I. General information

NPI: 1306961131
Provider Name (Legal Business Name): ALBUQUERQUE COLLABORATIVE THERAPEUTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND DR SE SUITE E
ALBUQUERQUE NM
87108-2778
US

IV. Provider business mailing address

301 GRACELAND DR SE SUITE E
ALBUQUERQUE NM
87108-2778
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1756
  • Fax: 505-255-1293
Mailing address:
  • Phone: 505-255-1756
  • Fax: 505-255-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BETH O'ROURKE
Title or Position: OWNER
Credential: LISW
Phone: 505-255-1756