Provider Demographics
NPI:1821596578
Name:A WELL OF HOPE
Entity Type:Organization
Organization Name:A WELL OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-226-1800
Mailing Address - Street 1:2235 ALEXANDRA LANE
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002
Mailing Address - Country:US
Mailing Address - Phone:505-539-5290
Mailing Address - Fax:888-503-7522
Practice Address - Street 1:3200 CARLISLE BLVD NE
Practice Address - Street 2:STE #220
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-907-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0082261106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty