Healthcare Provider Details

I. General information

NPI: 1437814670
Provider Name (Legal Business Name): COMPLETELY YOU WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 PALOMAS DR NE
ALBUQUERQUE NM
87110-3121
US

IV. Provider business mailing address

3167 SAN MATEO BLVD NE # 249
ALBUQUERQUE NM
87110-1921
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-1331
  • Fax: 505-554-3435
Mailing address:
  • Phone: 505-220-1330
  • Fax: 505-554-3435

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: JENNIFER DAVIS
Title or Position: OWNER
Credential: LCSW
Phone: 505-220-1330