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General NPI Number Information
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NPI Number | 1750370847
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Entity Type | Organization
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Legal Business Name | CHILDREN'S TREATMENT CENTER
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 07/22/2014
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Provider Practice Location Address
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Address Line | 6611 GULTON CT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4407
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Country | US
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Telephone | 505-296-3965
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Fax | 505-323-9430
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Provider Business Mailing Address
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Address Line | 6611 GULTON CT NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4407
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Country | US
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Telephone | 505-296-3965
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Fax | 505-323-9430
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. LESLIE ANN DOZZO
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Credential | PHD
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Telephone | 505-296-3965
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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 | CU00006637
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | CU00006637
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License Number State | NM
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