Provider Demographics
NPI:1720859911
Name:TWO CITIES THERAPY LLC
Entity type:Organization
Organization Name:TWO CITIES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:HOAGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-907-6084
Mailing Address - Street 1:933 SAN MATEO BLVD NE
Mailing Address - Street 2:STE 500, PMB 133
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-907-6084
Mailing Address - Fax:
Practice Address - Street 1:230 ADAMS ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-907-6084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty