Provider Demographics
NPI: | 1134332158 |
---|---|
Name: | INNER GUIDANCE, LC |
Entity Type: | Organization |
Organization Name: | INNER GUIDANCE, LC |
Other - Org Name: | ATTACHMENT HEALING CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COLEMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD LMFT |
Authorized Official - Phone: | 505-237-0061 |
Mailing Address - Street 1: | 1025 HERMOSA DR SE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87108-4312 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-237-0061 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1025 HERMOSA DR SE |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87108-4312 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-237-0061 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-07 |
Last Update Date: | 2017-02-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NM | 31072577 | Medicaid |