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General NPI Number Information
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NPI Number | 1669622189
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Entity Type | Organization
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Legal Business Name | FAMILIES TOGETHER/SELF REALIZATION THERAPY
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 9004 MENAUL BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2259
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Country | US
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Telephone | 505-440-6009
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Fax | 505-332-8549
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Provider Business Mailing Address
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Address Line | 4938 ARROYO CHAMISA RD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3716
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Country | US
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Telephone | 505-332-8549
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Fax | 505-332-8549
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. CHRISTINE RENEE ACKLEN
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Credential | LISW
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Telephone | 505-332-8549
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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 | I05822
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License Number State | NM
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