Healthcare Provider Details

I. General information

NPI: 1801776281
Provider Name (Legal Business Name): THERESA THURGOOD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

4639 GRANDE DR NW
ALBUQUERQUE NM
87107-3420
US

V. Phone/Fax

Practice location:
  • Phone: 505-430-0934
  • Fax:
Mailing address:
  • Phone: 505-430-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0801
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: