Healthcare Provider Details

I. General information

NPI: 1144932302
Provider Name (Legal Business Name): UMOJA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1678
US

IV. Provider business mailing address

3150 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-1678
US

V. Phone/Fax

Practice location:
  • Phone: 505-663-6163
  • 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: MOLLIE (LEILA) KELLY
Title or Position: THERAPIST
Credential:
Phone: 505-314-6037