Lifespan Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

4880277 Issued in NM

Legal business name

LIFESPAN WELLNESS LLC

Practice address

8200 Mountain Rd NE Ste 101
Albuquerque, NM 87110-7835

Phone

(505) 385-0161

Fax

(505) 544-4648

NPI assigned

Nov 1, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Erika K Johnson-Jimenez, PH.D.NPI 1548472806

Title

Psychologist

Phone

(505) 386-0063

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erika K. Johnson-Jimenez, PH.D.

  • Clinical Psychologist
  • Albuquerque, NM
  • NPI 1548472806
  Authorized official Same address or phone

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

{
    "created_epoch": "1414800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790180743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8200 MOUNTAIN RD NE STE 101",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107835",
            "telephone_number": "505-385-0161",
            "fax_number": "505-544-4648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 MOUNTAIN RD NE STE 101",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107835",
            "telephone_number": "505-385-0161",
            "fax_number": "505-544-4648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-JIMENEZ",
        "authorized_official_first_name": "ERIKA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "505-386-0063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "4880277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.