Healthcare Provider Details

I. General information

NPI: 1659870525
Provider Name (Legal Business Name): NURTURING INSIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 COWBOY WAY
EDGEWOOD NM
87015-9616
US

IV. Provider business mailing address

215 COWBOY WAY
EDGEWOOD NM
87015-9616
US

V. Phone/Fax

Practice location:
  • Phone: 505-926-1575
  • Fax: 505-629-0521
Mailing address:
  • Phone: 505-926-1575
  • Fax: 505-629-0521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10230
License Number StateNM

VIII. Authorized Official

Name: KELLIE ANN TOMLIN
Title or Position: OWNER
Credential: LCSW
Phone: 505-926-1575