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General NPI Number Information
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NPI Number | 1902510845
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Entity Type | Organization
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Legal Business Name | PRO SOCIAL THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 7517 DEERFIELD RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-4532
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Country | US
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Telephone | 541-525-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 7517 DEERFIELD RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-4532
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Country | US
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Telephone | 541-525-6463
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LUKE MITCHELL
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Credential | OTR/L
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Telephone | 505-521-0192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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