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General NPI Number Information
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NPI Number | 1659870525
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Entity Type | Organization
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Legal Business Name | NURTURING INSIGHT LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 215 COWBOY WAY
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City | EDGEWOOD
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State | NM
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Zip | 87015-9616
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Country | US
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Telephone | 505-926-1575
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Fax | 505-629-0521
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Provider Business Mailing Address
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Address Line | 215 COWBOY WAY
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City | EDGEWOOD
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State | NM
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Zip | 87015-9616
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Country | US
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Telephone | 505-926-1575
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Fax | 505-629-0521
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Authorized Official
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Title or Position | OWNER
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Name | KELLIE ANN TOMLIN
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Credential | LCSW
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Telephone | 505-926-1575
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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 | C-10230
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License Number State | NM
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