Provider Demographics
NPI:1891331773
Name:HEAD TO TOE WELLNESS, LLC
Entity Type:Organization
Organization Name:HEAD TO TOE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEDEZMA-CHINCHILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-417-3824
Mailing Address - Street 1:PO BOX 67098
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-7098
Mailing Address - Country:US
Mailing Address - Phone:505-417-3824
Mailing Address - Fax:
Practice Address - Street 1:4619 GREENE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-289-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty