Healthcare Provider Details

I. General information

NPI: 1023574431
Provider Name (Legal Business Name): TRAUMA RECOVERY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 INDIAN SCHOOL RD NE STE 235
ALBUQUERQUE NM
87110-4172
US

IV. Provider business mailing address

11904 GIACOMO AVE SE
ALBUQUERQUE NM
87123-2497
US

V. Phone/Fax

Practice location:
  • Phone: 505-321-2616
  • Fax:
Mailing address:
  • Phone: 505-321-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA HELLER NELLOS
Title or Position: CO-OWNER
Credential: LPCC
Phone: 505-321-2616