Organization
ILLUMINE INTEGRATIVE THERAPEUTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE DALEN PH.D. (OWNER)
(505) 796-2975
Entity
Organization
Contact information
Practice address
707 BROADWAY BLVD NE, SUITE 402, ALBUQUERQUE, NM 87102-2360
(505) 796-2975
Mailing address
20 SANTA ANA LOOP, PLACITAS, NM 87043-9440
(505) 796-2975
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1339
NM
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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