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General NPI Number Information
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NPI Number | 1437965415
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Entity Type | Organization
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Legal Business Name | LISTO HEALTH LLC
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 5400 GIBSON BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5566
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Country | US
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Telephone | 505-418-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 GIBSON BLVD SE STE 4
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5181
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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 | CEO
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Name | ALEX MCCABE
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Credential |
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Telephone | 505-418-1777
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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