MEDICARE: ANEMOS HEALING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013793355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANEMOS HEALING, LLC

Provider Business Mailing Address
First Line	:	6923 KAYSER MILL RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5976
Country	:	US
Telephone Number	:	505-387-9003
Fax Number	:

Provider Business Practice Location Address
First Line	:	6923 KAYSER MILL RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-5976
Country	:	US
Telephone Number	:	505-387-9003
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MS. JACQUELINE MICHELLE CLIFFORD
Credential	:	LCSW
Telephone Number	:	505-236-3579

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	09/14/2023

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Directions to “ANEMOS HEALING, LLC ” Practice Location

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