# ELEMENTAL HEALTH AND WELLNESS CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891125183
- **Authorized official:** ANNE CANNON (OWNER)
- **Authorized official phone:** (505) 503-6800

## Contact information

- **Practice address:** 4425 JUAN TABO BLVD NE STE 112, ALBUQUERQUE, NM 87111-2684
- **Practice address phone:** (505) 503-6800
- **Mailing address:** 4425 JUAN TABO BLVD NE STE 112, ALBUQUERQUE, NM 87111-2684
- **Mailing address phone:** (505) 503-6800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 0112181 | NM | — |
| 106H00000X | Marriage & Family Therapist | 0084711 | NM | Yes |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | CNP-02033 | NM | — |

## Other

- **Enumeration date:** 11/22/2013
- **Last updated:** 10/13/2023