Healthcare Provider Details

I. General information

NPI: 1316098346
Provider Name (Legal Business Name): THERAPEUTIC LIVING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DOMINGO RD NE
ALBUQUERQUE NM
87108-1610
US

IV. Provider business mailing address

5601 DOMINGO RD NE
ALBUQUERQUE NM
87108-1610
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-5295
  • Fax: 505-268-9967
Mailing address:
  • Phone: 505-268-5295
  • Fax: 505-268-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA L CHURCH
Title or Position: EXECUTIVE DIRECTOR
Credential: LPPC
Phone: 505-268-5295