Provider Demographics
NPI:1275804213
Name:CHILDHOOD IS CALLING, LLC
Entity Type:Organization
Organization Name:CHILDHOOD IS CALLING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-268-1456
Mailing Address - Street 1:1523 COLUMBIA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2634
Mailing Address - Country:US
Mailing Address - Phone:505-268-1456
Mailing Address - Fax:505-256-4866
Practice Address - Street 1:1523 COLUMBIA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2634
Practice Address - Country:US
Practice Address - Phone:505-268-1456
Practice Address - Fax:505-256-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0816103T00000X, 103TC2200X, 103TF0000X
TX25095103T00000X, 103TC2200X, 103TF0000X
TX30083103TS0200X
NM302062103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82653071Medicaid