Provider Demographics
NPI:1952770174
Name:DAVIDSON THERAPEUTIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:DAVIDSON THERAPEUTIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-363-8280
Mailing Address - Street 1:201 EUBANK BLVD NE
Mailing Address - Street 2:SUITE D-2B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2759
Mailing Address - Country:US
Mailing Address - Phone:505-363-8280
Mailing Address - Fax:
Practice Address - Street 1:201 EUBANK BLVD NE
Practice Address - Street 2:SUITE D-2B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-2759
Practice Address - Country:US
Practice Address - Phone:505-363-8280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1912064908Medicaid