Healthcare Provider Details

I. General information

NPI: 1174406987
Provider Name (Legal Business Name): CHANGING SEASONS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WYOMING BLVD NE STE 212
ALBUQUERQUE NM
87112-1033
US

IV. Provider business mailing address

119 QUAIL HILL TRL
PENA BLANCA NM
87041-5106
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-1105
  • Fax: 888-830-6839
Mailing address:
  • Phone: 505-288-1105
  • 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: DOMINICA MONTANO
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 505-288-1105