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1709 Moon St Ne Albuquerque NM 87112-3935 | |
| (505) 271-0329 | |
| (505) 271-4957 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1709 Moon St Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Krisztina Ford (CEO/PRESIDENT) |
| Authorized Official Contact | 5052710329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1709 Moon St Ne Albuquerque NM 87112-3935 Ph: (505) 271-0329 | 1709 Moon St Ne Albuquerque NM 87112-3935 Ph: (505) 271-0329 |
| NPI Number | 1093935959 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 07/28/2016 |
| Medicare PECOS PAC ID | 9537517149 |
|---|---|
| Medicare Enrollment ID | O20231120003542 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093935959 | NPI | - | NPPES |
| 65224086 | Medicaid | NM | |
| M1099 | Medicaid | NM | |
| NM600027 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | M1099 (New Mexico) | Secondary |
| 261QR0800X | Clinic/center - Recovery Care | M1099 (New Mexico) | Primary |
| Provider Name | Denise Clement |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023241098 PECOS PAC ID: 5294022901 Enrollment ID: I20160923001166 |
| Provider Name | Isidro Vigil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548677818 PECOS PAC ID: 1850749466 Enrollment ID: I20231120003685 |
| Provider Name | Sonya Juanita Briones-parks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528343506 PECOS PAC ID: 8224573522 Enrollment ID: I20240711000265 |
| Provider Name | Gabrielle A Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922729276 PECOS PAC ID: 5597121483 Enrollment ID: I20240724002997 |
| Provider Name | Laura K Heinis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801129986 PECOS PAC ID: 9931645066 Enrollment ID: I20240724003414 |
| Provider Name | Sabrina Montoya |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932583838 PECOS PAC ID: 0547706608 Enrollment ID: I20240724004390 |
| Provider Name | Samantha Kirie Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881235869 PECOS PAC ID: 0244776334 Enrollment ID: I20240725000926 |
| Provider Name | Donna Marie Lucero |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912065723 PECOS PAC ID: 9335685270 Enrollment ID: I20240726002516 |
| Provider Name | Jennifer Lynn Sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811442791 PECOS PAC ID: 3476099292 Enrollment ID: I20240729001163 |
| Provider Name | Kate S. Godsey |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1003325770 PECOS PAC ID: 0042745382 Enrollment ID: I20241125000490 |
| Provider Name | Heidi Mae Gall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003420696 PECOS PAC ID: 8729513643 Enrollment ID: I20241130000184 |
Integrated Healthcare Of New Mexico Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 7632 William Moyers Ave Ne, Albuquerque, NM 87122 Phone: 505-554-1716 Fax: 505-792-5222 | |
Lotus Behavioral Health Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4010 Carlisle Blvd Ne, Albuquerque, NM 87107 Phone: 401-954-1397 | |
Choices Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3620 Wyoming Blvd Ne, Suite L3, Albuquerque, NM 87111 Phone: 505-730-6791 Fax: 505-814-5740 | |
Broken Arrow Counseling Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 840 Simon Ln Sw, Albuquerque, NM 87105 Phone: 505-818-7934 | |
Mind Over Matters Holistic Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2424 Palomas Dr Ne, Albuquerque, NM 87110 Phone: 505-459-6980 | |
Solamente Holistic Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 833 Lomas Blvd Nw, Albuquerque, NM 87102 Phone: 505-243-6353 | |
Drgmed, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Gold Ave Sw Ste 1060, Albuquerque, NM 87102 Phone: 305-450-9651 Fax: 305-418-7511 |