Provider Demographics
NPI:1043755002
Name:THEMIS TRAINING AND CONSULTING LLC
Entity Type:Organization
Organization Name:THEMIS TRAINING AND CONSULTING LLC
Other - Org Name:THUNDERBIRD RISING RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RETTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-463-1970
Mailing Address - Street 1:6704 NUEVA PIEDRA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3618
Mailing Address - Country:US
Mailing Address - Phone:505-463-1970
Mailing Address - Fax:
Practice Address - Street 1:1258 ORTIZ DR SE # 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5592
Practice Address - Country:US
Practice Address - Phone:505-463-1970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM80273521Medicaid