Healthcare Provider Details

I. General information

NPI: 1952960312
Provider Name (Legal Business Name): LOVE IS HEALING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 DARTMOUTH DR SE APT D
ALBUQUERQUE NM
87106-2261
US

IV. Provider business mailing address

120 DARTMOUTH DR SE APT D
ALBUQUERQUE NM
87106-2261
US

V. Phone/Fax

Practice location:
  • Phone: 505-333-9042
  • Fax:
Mailing address:
  • Phone: 505-333-9042
  • Fax: 505-796-5475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MAGNOLIA BEATRIZ GONZALEZ HEATON
Title or Position: FOUNDER, CLINICAL DIRECTOR
Credential: LCSW
Phone: 505-333-9042