Provider Demographics
NPI:1467689885
Name:FORENSIC TREATMENT SERVICES
Entity Type:Organization
Organization Name:FORENSIC TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADAC
Authorized Official - Phone:505-350-5907
Mailing Address - Street 1:4 LEIBEL CT
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-5241
Mailing Address - Country:US
Mailing Address - Phone:505-350-5907
Mailing Address - Fax:
Practice Address - Street 1:111 GOLD AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3430
Practice Address - Country:US
Practice Address - Phone:505-350-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0093551251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health