Healthcare Provider Details

I. General information

NPI: 1134994411
Provider Name (Legal Business Name): MIND GARDEN THERAPY NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

IV. Provider business mailing address

1503 UNIVERSITY BLVD NE
ALBUQUERQUE NM
87102-1708
US

V. Phone/Fax

Practice location:
  • Phone: 510-328-0454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN B MORRIS
Title or Position: OWNER
Credential: LCSW
Phone: 510-328-0454