Provider Demographics
NPI:1841418019
Name:SOUTHWEST PSYCHOTHERAPY, INC
Entity Type:Organization
Organization Name:SOUTHWEST PSYCHOTHERAPY, INC
Other - Org Name:SUSAN LANE LPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-830-1200
Mailing Address - Street 1:560 BERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:505-830-1200
Mailing Address - Fax:505-830-1203
Practice Address - Street 1:4810 HARDWARE DR NE
Practice Address - Street 2:SUITE 5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-830-1200
Practice Address - Fax:505-830-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health