Healthcare Provider Details

I. General information

NPI: 1982709663
Provider Name (Legal Business Name): LOUGHEAD GROUP, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5712 OSUNA RD NE STE 6
ALBUQUERQUE NM
87109-2576
US

IV. Provider business mailing address

5800 CANYON VISTA DR NE
ALBUQUERQUE NM
87111-6616
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-6211
  • Fax: 505-857-0329
Mailing address:
  • Phone: 505-250-6211
  • Fax: 505-857-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05280
License Number StateNM

VIII. Authorized Official

Name: ANNA MARIE P. LOUGHEAD
Title or Position: PRESIDENT
Credential: LISW
Phone: 505-250-6211