Healthcare Provider Details

I. General information

NPI: 1013069434
Provider Name (Legal Business Name): THERAPY IS FUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 OPEN RANGE AVE SW
LOS LUNAS NM
87031-6389
US

IV. Provider business mailing address

330 OPEN RANGE AVE SW
LOS LUNAS NM
87031-6389
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-0695
  • Fax: 505-565-0695
Mailing address:
  • Phone: 505-565-0695
  • Fax: 505-565-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2504
License Number StateNM

VIII. Authorized Official

Name: MRS. ELIZABETH CAROL RAMEY
Title or Position: OWNER
Credential:
Phone: 505-565-0695