Provider Demographics
NPI:1346586989
Name:WELLNESS FROM WITHIN PC
Entity Type:Organization
Organization Name:WELLNESS FROM WITHIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HERRERA-SPINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, DSW
Authorized Official - Phone:505-459-0025
Mailing Address - Street 1:PO BOX 66255
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-6255
Mailing Address - Country:US
Mailing Address - Phone:505-459-0025
Mailing Address - Fax:
Practice Address - Street 1:10052 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4020
Practice Address - Country:US
Practice Address - Phone:505-459-0025
Practice Address - Fax:505-899-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-01
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10157344Medicaid