Provider Demographics
NPI:1508633405
Name:WOMEN IN LEADERSHIP NEW MEXICO INC
Entity Type:Organization
Organization Name:WOMEN IN LEADERSHIP NEW MEXICO INC
Other - Org Name:WOMEN IN LEADERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLESON
Authorized Official - Suffix:
Authorized Official - Credentials:CPSW
Authorized Official - Phone:505-322-9850
Mailing Address - Street 1:300 CENTRAL AVE SW
Mailing Address - Street 2:1500 EAST
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-369-1731
Mailing Address - Fax:
Practice Address - Street 1:300 CENTRAL AVE SW
Practice Address - Street 2:1500 EAST
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-369-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty