| Allison Benton Goss, Llc | |
|
1400 Carlisle Blvd Ne Suite A Albuquerque NM 87110-5667 | |
| (505) 266-2997 | |
| (505) 266-3063 |
| Full Name | Allison Benton Goss, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1400 Carlisle Blvd Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Allison Benton Goss (MEMBER) |
| Authorized Official Contact | 5052662997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Allison Benton Goss, Llc 1400 Carlisle Blvd Ne Suite A Albuquerque NM 87110-5667 Ph: (505) 266-2997 | Allison Benton Goss, Llc 1400 Carlisle Blvd Ne Suite A Albuquerque NM 87110-5667 Ph: (505) 266-2997 |
| NPI Number | 1679710677 |
|---|---|
| Provider Enumeration Date | 01/13/2009 |
| Last Update Date | 03/27/2009 |
| Medicare PECOS PAC ID | 7012066574 |
|---|---|
| Medicare Enrollment ID | O20090513000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679710677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Allison Benton Goss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326112442 PECOS PAC ID: 4981703113 Enrollment ID: I20070628000240 |
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