Organization
PIVOTAL TREATMENT GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTINE LOPEZ-BOWERS LPCC (OWNER)
(505) 796-2095
Entity
Organization
Contact information
Practice address
2549 TWIN BUTTES DR NE, RIO RANCHO, NM 87144-6742
(505) 796-2095
Mailing address
2549 TWIN BUTTES DR NE, RIO RANCHO, NM 87144-6742
(505) 796-2095
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0152101
NM
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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