Active Integration Therapy, LLC
NPI #1063045029 in Los Alamos, New Mexico
Provider Information
- NPI Number
- 1063045029
- Entity Type
- Organization
- Organization Name
- Active Integration Therapy, LLC
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- Feb 18, 2020
- Last Updated
- Feb 18, 2020
Practice Location
- Address
- 3250 TRINITY DR STE B1
- City
- Los Alamos
- State
- New Mexico
- ZIP Code
- 87544-2226
- Phone
- (505) 695-2095
Authorized Official
- Name
- MICHELLE WILDE, LPCC, LMT
- Title
- MEMBER
- Phone
- (505) 412-8360
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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