Provider Demographics
NPI:1568884690
Name:INTERVENTION & PREVENTION NETWORK
Entity Type:Organization
Organization Name:INTERVENTION & PREVENTION NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:SAN-CLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-264-4457
Mailing Address - Street 1:1001 LUNA CIR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1973
Mailing Address - Country:US
Mailing Address - Phone:505-264-4457
Mailing Address - Fax:505-345-1295
Practice Address - Street 1:1001 LUNA CIR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1973
Practice Address - Country:US
Practice Address - Phone:505-264-4457
Practice Address - Fax:505-345-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161331251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health