Healthcare Provider Details

I. General information

NPI: 1275804213
Provider Name (Legal Business Name): CHILDHOOD IS CALLING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 COLUMBIA DR NE
ALBUQUERQUE NM
87106-2634
US

IV. Provider business mailing address

1523 COLUMBIA DR NE
ALBUQUERQUE NM
87106-2634
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-1456
  • Fax: 505-256-4866
Mailing address:
  • Phone: 505-268-1456
  • Fax: 505-256-4866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number25095
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0816
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number25095
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number0816
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number25095
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number30083
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number302062
License Number StateNM
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0816
License Number StateNM

VIII. Authorized Official

Name: DR. DANIEL J GALLEGOS JR.
Title or Position: PSYCHOLOGIST
Credential: PH.D
Phone: 505-268-1456