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General NPI Number Information
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NPI Number | 1578776738
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Entity Type | Organization
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Legal Business Name | IN GOD WE TRUST RECOVERY INC.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4 ARCHULETA RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-9756
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Country | US
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Telephone | 505-751-1223
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Fax | 505-751-1223
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Provider Business Mailing Address
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Address Line | 4 ARCHULETA RD
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City | RANCHOS DE TAOS
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State | NM
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Zip | 87557-9756
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Country | US
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Telephone | 505-751-1223
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Fax | 505-751-1223
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. TIM MYLET
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Credential | LSAA
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Telephone | 505-751-1223
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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 | 0077511
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License Number State | NM
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