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General NPI Number Information
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NPI Number | 1437554961
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Entity Type | Organization
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Legal Business Name | THE COUPLE AND FAMILY THERAPY CENTER OF NEW MEXICO LLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/29/2014
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Provider Practice Location Address
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Address Line | 4010 CARLISLE BLVD NE STE G
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-4532
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Country | US
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Telephone | 505-414-3883
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10762
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City | ALBUQUERQUE
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State | NM
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Zip | 87184-0762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMANDA GATELY
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Credential | LMFT
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Telephone | 505-414-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 03303958005
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License Number State | NM
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