Healthcare Provider Details

I. General information

NPI: 1407730609
Provider Name (Legal Business Name): THIRD WAVE PSYCHOTHERAPY OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE STE 345
ALBUQUERQUE NM
87111-7351
US

IV. Provider business mailing address

10400 ACADEMY RD NE STE 345
ALBUQUERQUE NM
87111-7351
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-6100
  • Fax: 505-212-0042
Mailing address:
  • Phone: 505-345-6100
  • Fax: 505-212-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAE LITTLEWOOD
Title or Position: OWNER
Credential: PHD
Phone: 505-977-7972