Provider Demographics
NPI:1528757424
Name:RHIZOME THERAPEUTICS LLC
Entity type:Organization
Organization Name:RHIZOME THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-633-7170
Mailing Address - Street 1:300 MENAUL BLVD NW STE A-216
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1322
Mailing Address - Country:US
Mailing Address - Phone:505-633-7170
Mailing Address - Fax:
Practice Address - Street 1:300 MENAUL BLVD NW STE A-216
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1322
Practice Address - Country:US
Practice Address - Phone:505-633-7170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty