Healthcare Provider Details

I. General information

NPI: 1396237848
Provider Name (Legal Business Name): INTELLIGENT HYPNOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

4801 LANG AVE NE STE 110
ALBUQUERQUE NM
87109-4475
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-2552
  • Fax:
Mailing address:
  • Phone: 505-798-2552
  • Fax: 505-796-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GARY NEUGER
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 505-798-2552