Organization
KINTSUGI BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VYVIAN PHAN LCSW (CO-OWNER)
(505) 702-9080
Entity
Organization
Contact information
Practice address
948 CAMINO DE LA TIERRA, CORRALES, NM 87048-6909
(505) 352-4674
Mailing address
948 CAMINO DE LA TIERRA, CORRALES, NM 87048-6909
(505) 352-4674
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/21/2025
Last updated
01/28/2026
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