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General NPI Number Information
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NPI Number | 1245554419
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Entity Type | Organization
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Legal Business Name | ALBUQUERQUE HEALTH SERVICES
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 172 MONTANO RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-5030
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Country | US
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Telephone | 505-344-4427
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Fax |
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Provider Business Mailing Address
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Address Line | 172 MONTANO RD. NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107
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Country | US
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Telephone | 505-344-4427
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SIVAN WILSON
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Credential | PSYD
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Telephone | 505-260-9917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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