Healthcare Provider Details

I. General information

NPI: 1477268084
Provider Name (Legal Business Name): UNCAGED THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

IV. Provider business mailing address

500 MARQUETTE AVE NW STE 1200
ALBUQUERQUE NM
87102-5312
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-9686
  • Fax:
Mailing address:
  • Phone: 505-620-9686
  • 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: LISA ANDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 505-620-9686