Healthcare Provider Details

I. General information

NPI: 1932947199
Provider Name (Legal Business Name): ALBUQUERQUE MIND BRAIN & BODY INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 LOMAS BLVD NW STE C
ALBUQUERQUE NM
87102-1894
US

IV. Provider business mailing address

1715 CHACOMA PL SW
ALBUQUERQUE NM
87104-1108
US

V. Phone/Fax

Practice location:
  • Phone: 801-589-0043
  • Fax:
Mailing address:
  • Phone: 801-589-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BROCK FROST
Title or Position: MEDICAL PSYCHOLOGIST
Credential: PHD
Phone: 801-589-0043