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General NPI Number Information
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NPI Number | 1528813508
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Entity Type | Organization
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Legal Business Name | BEST SELF THERAPY LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 2201 MENAUL BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1711
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Country | US
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Telephone | 917-854-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 MENAUL BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-1711
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Country | US
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Telephone | 917-854-6331
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Fax |
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Authorized Official
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Title or Position | LICSW
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Name | KYLE MICHAEL ROUCKUS
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Credential |
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Telephone | 505-363-3313
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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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