Provider Demographics
NPI:1184363277
Name:SANDIA SOL THERAPY LLC
Entity type:Organization
Organization Name:SANDIA SOL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MBA
Authorized Official - Phone:505-604-9578
Mailing Address - Street 1:PO BOX 91987
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1987
Mailing Address - Country:US
Mailing Address - Phone:505-226-3042
Mailing Address - Fax:
Practice Address - Street 1:4004 CARLISLE BLVD NE STE C3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4565
Practice Address - Country:US
Practice Address - Phone:505-226-3042
Practice Address - Fax:505-441-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36854719Medicaid