| Roots Eco-therapy, Llc | |
|
8 Moots Ct Tijeras NM 87059-7004 | |
| (505) 363-3933 | |
| Not Available |
| Full Name | Roots Eco-therapy, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 8 Moots Ct, Tijeras, New Mexico |
| Authorized Official Name and Position | Karla G Ismay (OWNER/OPERATOR) |
| Authorized Official Contact | 5053633933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roots Eco-therapy, Llc 8 Moots Ct Tijeras NM 87059-7004 Ph: (505) 363-3933 | Roots Eco-therapy, Llc 8 Moots Ct Tijeras NM 87059-7004 Ph: (505) 363-3933 |
| NPI Number | 1255966644 |
|---|---|
| Provider Enumeration Date | 03/06/2020 |
| Last Update Date | 03/06/2020 |
| Certification Date | 03/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255966644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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