Healthcare Provider Details

I. General information

NPI: 1336445295
Provider Name (Legal Business Name): ALBUQUERQUE CENTER FOR THE TREATMENT OF EATING DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11930 MENAUL BLVD NE SUITE 224-C
ALBUQUERQUE NM
87112-2478
US

IV. Provider business mailing address

11930 MENAUL BLVD NE SUITE 224-C
ALBUQUERQUE NM
87112-2478
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-6121
  • Fax:
Mailing address:
  • Phone: 505-266-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1291
License Number StateNM

VIII. Authorized Official

Name: MS. HOLLY ANN FINLAY
Title or Position: PRESIDENT
Credential: MA
Phone: 505-266-6121