| Rio Grande Emdr Therapy, Llc | |
|
2900 Louisiana Blvd Ne Ste 210 Albuquerque NM 87110-3569 | |
| (505) 304-9431 | |
| Not Available |
| Full Name | Rio Grande Emdr Therapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2900 Louisiana Blvd Ne Ste 210, Albuquerque, New Mexico |
| Authorized Official Name and Position | Sarah Penn (OWNER) |
| Authorized Official Contact | 5053049431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rio Grande Emdr Therapy, Llc 2900 Louisiana Blvd Ne Ste 210 Albuquerque NM 87110-3569 Ph: (505) 304-9431 | Rio Grande Emdr Therapy, Llc 2900 Louisiana Blvd Ne Ste 210 Albuquerque NM 87110-3569 Ph: (505) 304-9431 |
| NPI Number | 1861090342 |
|---|---|
| Provider Enumeration Date | 10/15/2020 |
| Last Update Date | 04/12/2021 |
| Certification Date | 04/12/2021 |
| Medicare PECOS PAC ID | 9739582016 |
|---|---|
| Medicare Enrollment ID | O20210723001781 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861090342 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Oshanna Washington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396211777 PECOS PAC ID: 0547663825 Enrollment ID: I20210723001821 |
| Provider Name | Jennifer Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639648736 PECOS PAC ID: 9931594975 Enrollment ID: I20220309002983 |
| Provider Name | Christine Sande |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356751226 PECOS PAC ID: 1052798303 Enrollment ID: I20220506002074 |
| Provider Name | Sarah Penn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144658204 PECOS PAC ID: 1557764834 Enrollment ID: I20231204001003 |
| Provider Name | Linda Cochrum |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245656115 PECOS PAC ID: 8022468842 Enrollment ID: I20231220000696 |
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