| Healing Roots Therapy Llc | |
|
4010 Carlisle Blvd Ne Ste F Albuquerque NM 87107-4532 | |
| (505) 720-3548 | |
| (505) 554-3435 |
| Full Name | Healing Roots Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4010 Carlisle Blvd Ne Ste F, Albuquerque, New Mexico |
| Authorized Official Name and Position | Daniel Gonzales (OWNER) |
| Authorized Official Contact | 5057203548 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Roots Therapy Llc 3932 La Sombra Rd Sw Albuquerque NM 87105-6135 Ph: (505) 720-3548 | Healing Roots Therapy Llc 4010 Carlisle Blvd Ne Ste F Albuquerque NM 87107-4532 Ph: (505) 720-3548 |
| NPI Number | 1285303859 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 07/05/2023 |
| Certification Date | 07/05/2023 |
| Medicare PECOS PAC ID | 8123481611 |
|---|---|
| Medicare Enrollment ID | O20230831000690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285303859 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Daniel Gonzales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285264903 PECOS PAC ID: 9032572524 Enrollment ID: I20230831000767 |
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