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General NPI Number Information
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NPI Number | 1477465425
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Entity Type | Organization
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Legal Business Name | PROUD MOMENTS ABA
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 10511 GOLF COURSE RD NW STE 103
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5917
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Country | US
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Telephone | 505-856-6880
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Fax |
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Provider Business Mailing Address
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Address Line | 10511 GOLF COURSE RD NW STE 103
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5917
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Country | US
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Telephone | 505-856-6880
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Fax |
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Authorized Official
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Title or Position | RECRUITER
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Name | BARBARA TISDALE
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Credential |
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Telephone | 718-215-5311
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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 |
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License Number State |
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