Organization
MANDALA INTEGRATED THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN M BROCK (OWNER)
(817) 729-9099
Entity
Organization
Contact information
Practice address
5201 VENICE AVE NE STE A, ALBUQUERQUE, NM 87113-2337
(505) 796-6367
Mailing address
5201 VENICE AVE NE STE A, ALBUQUERQUE, NM 87113-2337
(505) 796-6367
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/20/2022
Last updated
04/17/2026
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