Provider Demographics
NPI:1689906570
Name:TRAILHEADS COUNSELING & PSYCHOTHERAPY
Entity Type:Organization
Organization Name:TRAILHEADS COUNSELING & PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-350-4091
Mailing Address - Street 1:4233 MONTGOMERY BLVD. NE
Mailing Address - Street 2:BLDG J, SUITE 240
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-350-4091
Mailing Address - Fax:
Practice Address - Street 1:4233 MONTGOMERY BLVD. NE
Practice Address - Street 2:BLDG J, SUITE 240
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-350-4091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0093001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health