=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801461553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART IN HARMONY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2021
-----------------------------------------------------
Last Update Date | 09/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2601 WYOMING BLVD NE STE 203V
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87112-1033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-307-0871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3604 BRITT ST NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-4983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-307-0871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SW/DIRECTOR/OWNER
-----------------------------------------------------
Name | AMY FLINKO
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 505-307-0871
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------