Healthcare Provider Details

I. General information

NPI: 1861858698
Provider Name (Legal Business Name): TALKING CIRCLES THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

IV. Provider business mailing address

4169 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-6742
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-9770
  • Fax: 505-212-6747
Mailing address:
  • Phone: 505-261-9770
  • Fax: 505-212-6747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0173531
License Number StateNM

VIII. Authorized Official

Name: ERIKA NICOLE MARTINEZ-GONZALES
Title or Position: OWNER
Credential: LPCC
Phone: 505-261-9770