Healthcare Provider Details

I. General information

NPI: 1942878475
Provider Name (Legal Business Name): ATTACHMENT HEALING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

7428 GETTYSBURG RD NE
ALBUQUERQUE NM
87109-5026
US

V. Phone/Fax

Practice location:
  • Phone: 505-450-2571
  • Fax:
Mailing address:
  • Phone: 505-450-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK A WEST
Title or Position: BOARD MEMBER
Credential: RDN, LD, CLT, EPC
Phone: 505-385-8284