Provider Demographics
NPI:1255700787
Name:INNER STRENGTH MENTAL HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:INNER STRENGTH MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREMER QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-453-5089
Mailing Address - Street 1:11930 MENAUL BLVD NE STE 101A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2478
Mailing Address - Country:US
Mailing Address - Phone:505-453-5089
Mailing Address - Fax:
Practice Address - Street 1:11930 MENAUL BLVD NE STE 101A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2478
Practice Address - Country:US
Practice Address - Phone:505-453-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-091931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty