Organization
ELEMENTAL HEALTH AND WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE CANNON (OWNER)
(505) 503-6800
Entity
Organization
Contact information
Practice address
4425 JUAN TABO BLVD NE STE 112, ALBUQUERQUE, NM 87111-2684
(505) 503-6800
Mailing address
4425 JUAN TABO BLVD NE STE 112, ALBUQUERQUE, NM 87111-2684
(505) 503-6800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0112181
NM
106H00000X
Marriage & Family Therapist
Primary
0084711
NM
207Q00000X
Family Medicine Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
CNP-02033
NM
Other
Enumeration date
11/22/2013
Last updated
10/13/2023
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