Provider Demographics
NPI:1861858698
Name:TALKING CIRCLES THERAPY & WELLNESS
Entity Type:Organization
Organization Name:TALKING CIRCLES THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MARTINEZ-GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-261-9770
Mailing Address - Street 1:4004 CARLISLE BLVD NE STE A2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4566
Mailing Address - Country:US
Mailing Address - Phone:505-261-9770
Mailing Address - Fax:505-565-0040
Practice Address - Street 1:4004 CARLISLE BLVD NE STE A2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4566
Practice Address - Country:US
Practice Address - Phone:505-261-9770
Practice Address - Fax:505-565-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NM0173531251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70221243Medicaid