Provider Demographics
NPI:1306961131
Name:ALBUQUERQUE COLLABORATIVE THERAPEUTICS, INC.
Entity type:Organization
Organization Name:ALBUQUERQUE COLLABORATIVE THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-255-1756
Mailing Address - Street 1:301 GRACELAND DR SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2778
Mailing Address - Country:US
Mailing Address - Phone:505-255-1756
Mailing Address - Fax:505-255-1293
Practice Address - Street 1:301 GRACELAND DR SE
Practice Address - Street 2:SUITE E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2778
Practice Address - Country:US
Practice Address - Phone:505-255-1756
Practice Address - Fax:505-255-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD4179Medicaid