Provider Demographics
NPI:1407426141
Name:FOUR CIRCLES HEALING, LLC
Entity Type:Organization
Organization Name:FOUR CIRCLES HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MH COUNSELOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FREIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, BHC
Authorized Official - Phone:505-315-8213
Mailing Address - Street 1:6035 CYONUS AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114
Mailing Address - Country:US
Mailing Address - Phone:505-315-8213
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD. NE
Practice Address - Street 2:SUITE A2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-315-8213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM75972085Medicaid