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General NPI Number Information
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NPI Number | 1265007496
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Entity Type | Organization
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Legal Business Name | SOLID SOCIETY OF NEW MEXICO CORP
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 609 GOLD AVE SW STE 1F
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3119
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Country | US
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Telephone | 505-758-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 SAN MATEO BLVD NE # 191
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5146
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Country | US
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Telephone | 505-758-7200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. SCOTT THOMAS CLARK
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Credential | LPCC
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Telephone | 505-758-7200
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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