Healthcare Provider Details
I. General information
NPI: 1891892865
Provider Name (Legal Business Name): SYNCHRONICITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/20/2006
Last Update Date: 09/23/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
12412 MENAUL NE
ALBUQUERQUE NM
87112-2556
US
IV. Provider business mailing address
9214 LAS CAMAS RD NE
ALBUQUERQUE NM
87111-2432
US
V. Phone/Fax
- Phone: 505-710-1640
- Fax: 505-296-0878
- Phone: 505-710-1640
- Fax: 505-296-0878
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 402 |
| License Number State | NM |
VIII. Authorized Official
Name: MRS.
KARI
WARD
KARR
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 505-710-1640