Provider Demographics
NPI:1992571327
Name:TREE OF LIFE HEALING CENTER LLC
Entity type:Organization
Organization Name:TREE OF LIFE HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:HERRERA
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADAC
Authorized Official - Phone:505-859-9559
Mailing Address - Street 1:306 WASHINGTON ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2735
Mailing Address - Country:US
Mailing Address - Phone:505-859-9559
Mailing Address - Fax:
Practice Address - Street 1:306 WASHINGTON ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2735
Practice Address - Country:US
Practice Address - Phone:505-859-9559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)