Healthcare Provider Details

I. General information

NPI: 1235487372
Provider Name (Legal Business Name): THREE HEARTS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-1818
US

IV. Provider business mailing address

2201 SAN PEDRO DR NE STE 100
ALBUQUERQUE NM
87110-4133
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-1811
  • Fax: 505-274-7338
Mailing address:
  • Phone: 505-503-1811
  • Fax: 505-639-4309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-6807
License Number StateNM

VIII. Authorized Official

Name: ERIN M COLLINS
Title or Position: PROPRIETOR
Credential: LISW
Phone: 505-503-1811