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General NPI Number Information
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NPI Number | 1053835710
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Entity Type | Organization
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Legal Business Name | COPPER KEY PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 5920 CANYON VISTA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6621
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Country | US
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Telephone | 505-933-1807
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Fax | 505-856-1614
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Provider Business Mailing Address
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Address Line | 5920 CANYON VISTA DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6621
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Country | US
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Telephone | 505-933-1807
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Fax | 505-856-1614
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. SALLY EDEN MORETTI
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Credential | PSY.D.
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Telephone | 505-933-1807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1395
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License Number State | NM
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