| Mandala Integrated Therapy | |
|
5201 Venice Ave Ne Ste A Albuquerque NM 87113-2337 | |
| (505) 796-6367 | |
| Not Available |
| Full Name | Mandala Integrated Therapy |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5201 Venice Ave Ne Ste A, Albuquerque, New Mexico |
| Authorized Official Name and Position | Kathryn M Brock (OWNER) |
| Authorized Official Contact | 8177299099 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mandala Integrated Therapy 5201 Venice Ave Ne Ste A Albuquerque NM 87113-2337 Ph: (505) 796-6367 | Mandala Integrated Therapy 5201 Venice Ave Ne Ste A Albuquerque NM 87113-2337 Ph: (505) 796-6367 |
| NPI Number | 1225763568 |
|---|---|
| Provider Enumeration Date | 07/20/2022 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225763568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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