Healthcare Provider Details

I. General information

NPI: 1780573022
Provider Name (Legal Business Name): THE LEGEND OF HOPE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 LEAD AVE SE APT 16
ALBUQUERQUE NM
87106-4076
US

IV. Provider business mailing address

1811 LEAD AVE SE APT 16
ALBUQUERQUE NM
87106-4076
US

V. Phone/Fax

Practice location:
  • Phone: 505-549-7920
  • Fax:
Mailing address:
  • Phone: 877-416-6474
  • Fax: 505-355-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANE ELMAN
Title or Position: OWNER
Credential:
Phone: 877-416-6474