MEDICARE: COMPLETELY YOU WELLNESS, 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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437814670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETELY YOU WELLNESS, LLC

Provider Business Mailing Address
First Line	:	3167 SAN MATEO BLVD NE # 249
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1921
Country	:	US
Telephone Number	:	505-220-1330
Fax Number	:	505-554-3435

Provider Business Practice Location Address
First Line	:	2837 PALOMAS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3121
Country	:	US
Telephone Number	:	505-220-1331
Fax Number	:	505-554-3435

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER DAVIS
Credential	:	LCSW
Telephone Number	:	505-220-1330

Provider Enumeration Date	:	11/02/2021
Last Update Date	:	11/02/2021

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Directions to “COMPLETELY YOU WELLNESS, LLC ” Practice Location

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