Healthcare Provider Details

I. General information

NPI: 1265007496
Provider Name (Legal Business Name): SOLID SOCIETY OF NEW MEXICO CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GOLD AVE SW STE 1F
ALBUQUERQUE NM
87102-3119
US

IV. Provider business mailing address

1933 SAN MATEO BLVD NE # 191
ALBUQUERQUE NM
87110-5146
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-7200
  • Fax:
Mailing address:
  • Phone: 505-758-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT THOMAS CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC
Phone: 505-758-7200