Provider Demographics
NPI:1942080114
Name:MOVEMENT PSYCHOTHERAPY SERVICES LLC
Entity Type:Organization
Organization Name:MOVEMENT PSYCHOTHERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VYVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-702-9080
Mailing Address - Street 1:1855 SMARTY JONES ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2398
Mailing Address - Country:US
Mailing Address - Phone:505-702-9080
Mailing Address - Fax:
Practice Address - Street 1:4110 WOLCOTT AVE NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4598
Practice Address - Country:US
Practice Address - Phone:505-433-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health