Healthcare Provider Details

I. General information

NPI: 1356284475
Provider Name (Legal Business Name): OUROAXIS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 MONTANO PLAZA DR NW APT 26D
ALBUQUERQUE NM
87120-2476
US

IV. Provider business mailing address

6000 MONTANO PLAZA DR NW APT 26D
ALBUQUERQUE NM
87120-2476
US

V. Phone/Fax

Practice location:
  • Phone: 505-379-4035
  • Fax:
Mailing address:
  • Phone: 505-379-4035
  • 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: ISAAC J PENNER
Title or Position: OWNER
Credential: MA, LPCC
Phone: 505-379-4035