Organization
IDEAL SELF THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH BOGUSCH PHD (OWNER)
(505) 226-2191
Entity
Organization
Contact information
Practice address
720 8TH ST NE, RIO RANCHO, NM 87124-0791
(505) 226-2191
Mailing address
1209 MOUNTAIN ROAD PL NE STE N, ALBUQUERQUE, NM 87110-7845
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
03/29/2025
Last updated
03/29/2025
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