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General NPI Number Information
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NPI Number | 1770214223
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Entity Type | Organization
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Legal Business Name | BHAKTI BEHAVIORAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 10401 MONTGOMERY PKWY NE STE 1A
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-3876
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Country | US
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Telephone | 678-334-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 27 JEMA CT
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City | IOWA CITY
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State | IA
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Zip | 52246-4532
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Country | US
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Telephone | 678-334-6879
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR/ MEMBER
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Name | MR. LANCE T LASHLEY
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Credential | LCSW
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Telephone | 678-334-6879
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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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