Provider Demographics
NPI:1770175234
Name:ENCHANTMENT COUNSELING
Entity type:Organization
Organization Name:ENCHANTMENT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-999-0203
Mailing Address - Street 1:6300 MONTANO RD NW STE G1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1826
Mailing Address - Country:US
Mailing Address - Phone:505-999-0203
Mailing Address - Fax:505-999-0203
Practice Address - Street 1:6300 MONTANO RD NW STE G1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1826
Practice Address - Country:US
Practice Address - Phone:505-999-0203
Practice Address - Fax:505-999-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty