NPIMap

Organization Active NPI

Mandala Integrated Therapy LLC

  • Community/Behavioral Health Agency
  • Albuquerque, NM
National Provider Identifier
1225763568
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MANDALA INTEGRATED THERAPY LLC
Practice address
5200 Pasadena Ave NE Unit E
Albuquerque, NM 87113-2208
Phone
(505) 796-6367
Fax
(505) 533-2135
NPI assigned
Jul 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathryn M BrockNPI 1851058952
Title
Clinical Director
Phone
(817) 729-9099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

5200 Pasadena Ave NE Unit E
Albuquerque, NM 87113-2208

Mailing address

5200 Pasadena Ave NE Unit E
Albuquerque, NM 87113-2208
Phone (505) 796-6367

National Provider Directory

National Provider Directory

Locations

5201 Venice Ave NE
Ste A
Albuquerque, NM 87113
Phone (505) 796-6367

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1225763568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 PASADENA AVE NE UNIT E",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132208",
            "telephone_number": "505-796-6367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 PASADENA AVE NE UNIT E",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871132208",
            "telephone_number": "505-796-6367",
            "fax_number": "505-533-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDALA INTEGRATED THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-20",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A",
        "authorized_official_last_name": "BROCK",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "817-729-9099"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.