Healthcare Provider Details

I. General information

NPI: 1619697620
Provider Name (Legal Business Name): HOPE FORWARD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-4104
US

IV. Provider business mailing address

2521 SAN PEDRO DR NE STE F
ALBUQUERQUE NM
87110-4118
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-6869
  • Fax:
Mailing address:
  • Phone: 505-633-4107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: NATHAN BRUCH
Title or Position: ADMIN
Credential:
Phone: 505-453-3900