Provider Demographics
NPI:1578776738
Name:IN GOD WE TRUST RECOVERY INC.
Entity Type:Organization
Organization Name:IN GOD WE TRUST RECOVERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MYLET
Authorized Official - Suffix:
Authorized Official - Credentials:LSAA
Authorized Official - Phone:505-751-1223
Mailing Address - Street 1:4 ARCHULETA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-9756
Mailing Address - Country:US
Mailing Address - Phone:505-751-1223
Mailing Address - Fax:505-751-1223
Practice Address - Street 1:4 ARCHULETA RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557-9756
Practice Address - Country:US
Practice Address - Phone:505-751-1223
Practice Address - Fax:505-751-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0077511101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty