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General NPI Number Information
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NPI Number | 1306365929
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Entity Type | Organization
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Legal Business Name | CALYX INSTITUTE LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 12/08/2018
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Provider Practice Location Address
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Address Line | 10701 LOMAS BLVD NE, STE. 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87112
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Country | US
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Telephone | 505-379-3654
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1194
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City | TIJERAS
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State | NM
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Zip | 87059-1194
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Country | US
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Telephone | 505-652-7065
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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 | ANGELA TRUE
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Credential |
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Telephone | 505-652-7065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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