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General NPI Number Information
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NPI Number | 1437814670
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Entity Type | Organization
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Legal Business Name | COMPLETELY YOU WELLNESS, LLC
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Dates
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Enumeration Date | 11/02/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 2837 PALOMAS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3121
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Country | US
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Telephone | 505-220-1331
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Fax | 505-554-3435
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Provider Business Mailing Address
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Address Line | 3167 SAN MATEO BLVD NE # 249
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-1921
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Country | US
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Telephone | 505-220-1330
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Fax | 505-554-3435
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER DAVIS
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Credential | LCSW
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Telephone | 505-220-1330
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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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