Provider Demographics
NPI:1053820902
Name:SUPPORT IS APPARENT, LLC
Entity Type:Organization
Organization Name:SUPPORT IS APPARENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-226-1800
Mailing Address - Street 1:11600 HAINES AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4452
Mailing Address - Country:US
Mailing Address - Phone:505-620-2119
Mailing Address - Fax:505-445-4504
Practice Address - Street 1:9 GAUDIAN LOOP
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9555
Practice Address - Country:US
Practice Address - Phone:505-620-2119
Practice Address - Fax:505-445-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75700221Medicaid