Provider Demographics
NPI:1578743068
Name:CONSCIOUS HEALTH LLC
Entity Type:Organization
Organization Name:CONSCIOUS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:575-776-8012
Mailing Address - Street 1:98 STATE ROAD 150 STE 5
Mailing Address - Street 2:HC74 BOX 24813
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529
Mailing Address - Country:US
Mailing Address - Phone:575-776-8012
Mailing Address - Fax:
Practice Address - Street 1:98 STATE ROAD 150 STE 5
Practice Address - Street 2:HC74 BOX 24813
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529
Practice Address - Country:US
Practice Address - Phone:575-776-8012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM931171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty