Healthcare Provider Details

I. General information

NPI: 1295694651
Provider Name (Legal Business Name): UMOJA BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CARLISLE BLVD NE STE 105
ALBUQUERQUE NM
87110-1680
US

IV. Provider business mailing address

3150 CARLISLE BLVD NE STE 105
ALBUQUERQUE NM
87110-1680
US

V. Phone/Fax

Practice location:
  • Phone: 505-663-8173
  • Fax: 505-672-7769
Mailing address:
  • Phone: 505-663-8173
  • Fax: 505-672-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: JESSICA RUTH BROWN
Title or Position: MSW STUDENT INTERN
Credential:
Phone: 505-663-8173