Organization
SEA CHANGE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO ORTIZ (CREDENTIALING MANAGER)
(575) 707-8150
Entity
Organization
Contact information
Practice address
712 VALENCIA DR NE, ALBUQUERQUE, NM 87108-1750
(505) 463-6740
Mailing address
712 VALENCIA DR NE, ALBUQUERQUE, NM 87108-1750
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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