Healthcare Provider Details

I. General information

NPI: 1992562995
Provider Name (Legal Business Name): ANCHORED THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD NE STE 116
ALBUQUERQUE NM
87112-1000
US

IV. Provider business mailing address

8226 MENAUL BLVD NE # 623
ALBUQUERQUE NM
87110-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-633-0643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FERNANDO ORTIZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 575-707-8150