Healthcare Provider Details

I. General information

NPI: 1790601086
Provider Name (Legal Business Name): UNIQUE NEURO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 HARDWARE DR NE
ALBUQUERQUE NM
87109-2013
US

IV. Provider business mailing address

4810 HARDWARE DR NE
ALBUQUERQUE NM
87109-2013
US

V. Phone/Fax

Practice location:
  • Phone: 626-297-5284
  • Fax:
Mailing address:
  • Phone: 626-297-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BEAU RITCHIE
Title or Position: OWNER / OPERATIONS DIRECTOR
Credential:
Phone: 626-297-5284