Healthcare Provider Details

I. General information

NPI: 1902581358
Provider Name (Legal Business Name): TARIN LEIGH IHLEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 MENAUL BLVD NE STE B460
ALBUQUERQUE NM
87112-2250
US

IV. Provider business mailing address

9627 EUCLID AVE NE
ALBUQUERQUE NM
87112-2945
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-0104
  • Fax:
Mailing address:
  • Phone: 505-933-0257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2025-0764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: