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7520 Montgomery Blvd Ne Bldg E15 Albuquerque NM 87109-1586 | |
| (505) 226-6380 | |
| (505) 214-5852 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7520 Montgomery Blvd Ne Bldg E15, Albuquerque, New Mexico |
| Authorized Official Name and Position | Chavonne A. Mcclay Harroun (OWNER) |
| Authorized Official Contact | 5059858565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7520 Montgomery Blvd Ne Bldg E15 Albuquerque NM 87109-1586 Ph: (505) 226-6380 | 7520 Montgomery Blvd Ne Bldg E15 Albuquerque NM 87109-1586 Ph: (505) 226-6380 |
| NPI Number | 1942713151 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/22/2024 |
| Certification Date | 11/22/2024 |
| Medicare PECOS PAC ID | 6709145816 |
|---|---|
| Medicare Enrollment ID | O20180118001375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942713151 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | C-09259 (New Mexico) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Chavonne Andraya Mcclay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245505205 PECOS PAC ID: 1658508866 Enrollment ID: I20180118001437 |
| Provider Name | Jade Sanchez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124596119 PECOS PAC ID: 4486007127 Enrollment ID: I20240129003515 |
| Provider Name | Katherine Pamela Catanach |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1770112997 PECOS PAC ID: 8123562543 Enrollment ID: I20240626003757 |
| Provider Name | Ruth Yanez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376272310 PECOS PAC ID: 6406390350 Enrollment ID: I20240702002384 |
| Provider Name | Dulce A Medina Bustillos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619456126 PECOS PAC ID: 9638610678 Enrollment ID: I20240918002019 |
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