| Leading Edge Therapy Llc | |
|
102 Gold Ave Sw # 256 Albuquerque NM 87102-3335 | |
| (417) 501-9423 | |
| (505) 672-7769 |
| Full Name | Leading Edge Therapy Llc |
|---|---|
| Speciality | Psychologist |
| Location | 102 Gold Ave Sw # 256, Albuquerque, New Mexico |
| Authorized Official Name and Position | Jamie Marie Loor (OWNER) |
| Authorized Official Contact | 4175019423 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leading Edge Therapy Llc Po Box 45681 Rio Rancho NM 87174-5681 Ph: (505) 226-1960 | Leading Edge Therapy Llc 102 Gold Ave Sw # 256 Albuquerque NM 87102-3335 Ph: (417) 501-9423 |
| NPI Number | 1942012349 |
|---|---|
| Provider Enumeration Date | 01/22/2025 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/22/2025 |
| Medicare PECOS PAC ID | 6204356694 |
|---|---|
| Medicare Enrollment ID | O20250228002408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942012349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jamie Marie Loor |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750078820 PECOS PAC ID: 7012437403 Enrollment ID: I20250228002516 |
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