Organization
ACTIVE INTEGRATION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WILDE LPCC, LMT (MEMBER)
(505) 412-8360
Entity
Organization
Contact information
Practice address
3250 TRINITY DR STE B1, LOS ALAMOS, NM 87544-2226
(505) 695-2095
Mailing address
3250 TRINITY DR STE B1, LOS ALAMOS, NM 87544-2226
(505) 695-2095
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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