MEDICARE: MOVEMENT PSYCHOTHERAPY SERVICES 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1942080114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEMENT PSYCHOTHERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	1855 SMARTY JONES ST SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-2398
Country	:	US
Telephone Number	:	505-702-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 MONTGOMERY BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2468
Country	:	US
Telephone Number	:	505-702-9080
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VYVIAN PHAN
Credential	:	LCSW
Telephone Number	:	505-702-9080

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	06/20/2026

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Directions to “MOVEMENT PSYCHOTHERAPY SERVICES LLC ” Practice Location

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