Healthcare Provider Details

I. General information

NPI: 1649087990
Provider Name (Legal Business Name): THERESA HOWLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 29TH ST SE
RIO RANCHO NM
87124-5209
US

IV. Provider business mailing address

1380 RIO RANCHO BLVD SE # 262
RIO RANCHO NM
87124-1006
US

V. Phone/Fax

Practice location:
  • Phone: 505-218-6706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-07486
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: