Healthcare Provider Details

I. General information

NPI: 1497492276
Provider Name (Legal Business Name): RADICAL HOPE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9502 4TH ST NW
ALBUQUERQUE NM
87114-1634
US

IV. Provider business mailing address

PO BOX 10223
ALBUQUERQUE NM
87184-0223
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-3672
  • Fax:
Mailing address:
  • Phone: 505-250-3672
  • 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: JUAN E SANCHEZ
Title or Position: REGISTERED AGENT
Credential: LMFT
Phone: 505-250-3672