Provider Demographics
NPI:1871256933
Name:NOMADIC PSYCHOTHERAPY & WELLNESS COACHING, PLC.
Entity Type:Organization
Organization Name:NOMADIC PSYCHOTHERAPY & WELLNESS COACHING, PLC.
Other - Org Name:NOMADIC PSYCHOTHERAPY & WELLNESS COACHING, PLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CASTONGUAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC, LPCC, MHC
Authorized Official - Phone:802-760-8214
Mailing Address - Street 1:500 4TH ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2104
Mailing Address - Country:US
Mailing Address - Phone:802-760-8214
Mailing Address - Fax:
Practice Address - Street 1:2901 JUAN TABO BLVD NE # 101C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1886
Practice Address - Country:US
Practice Address - Phone:802-760-8214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)