| Kerri Wormwood, Llc | |
|
3200 Carlisle Ne, Suite 204 Albuquerque NM 87110 | |
| (505) 604-1222 | |
| (505) 889-4598 |
| Full Name | Kerri Wormwood, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3200 Carlisle Ne, Suite 204, Albuquerque, New Mexico |
| Authorized Official Name and Position | Kerri Faith Wormwood (CLINICAL COUNSELOR AND ART THERAPIS) |
| Authorized Official Contact | 5056041222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kerri Wormwood, Llc 3200 Carlisle Ne, Suite 204 Albuquerque NM 87110 Ph: (505) 604-1222 | Kerri Wormwood, Llc 3200 Carlisle Ne, Suite 204 Albuquerque NM 87110 Ph: (505) 604-1222 |
| NPI Number | 1336509348 |
|---|---|
| Provider Enumeration Date | 03/03/2016 |
| Last Update Date | 03/03/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336509348 | NPI | - | NPPES |
| 000A1775 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 1129 (New Mexico) | Primary |
| 221700000X | Art Therapist | 1128 (New Mexico) | Secondary |
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