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General NPI Number Information
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NPI Number | 1952770174
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Entity Type | Organization
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Legal Business Name | DAVIDSON THERAPEUTIC SOLUTIONS LLC
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 201 EUBANK BLVD NE SUITE D-2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2759
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Country | US
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Telephone | 505-363-8280
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Fax |
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Provider Business Mailing Address
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Address Line | 201 EUBANK BLVD NE SUITE D-2B
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2759
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Country | US
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Telephone | 505-363-8280
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROSS WILLIAM DAVIDSON
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Credential | LMFT
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Telephone | 505-363-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 005632
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License Number State | NM
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