Healthcare Provider Details

I. General information

NPI: 1790344224
Provider Name (Legal Business Name): FAITH & GRACE THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 03/14/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HANCOCK CT NE STE D
ALBUQUERQUE NM
87109-4592
US

IV. Provider business mailing address

7400 HANCOCK CT NE STE D
ALBUQUERQUE NM
87109-4592
US

V. Phone/Fax

Practice location:
  • Phone: 505-990-8576
  • Fax: 888-924-8181
Mailing address:
  • Phone: 505-990-8576
  • Fax: 888-924-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE L ROSS
Title or Position: CO-OWNER
Credential: PH.D., LMFT
Phone: 505-331-3644