NPIMap

Organization Active NPI

Elemental Health and Wellness Center LLC

  • Marriage & Family Therapist
  • Albuquerque, NM
National Provider Identifier
1891125183
Registry record updated Oct 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
0084711 Issued in NM
Legal business name
ELEMENTAL HEALTH AND WELLNESS CENTER LLC
Practice address
4425 Juan Tabo Blvd NE Ste 112
Albuquerque, NM 87111-2684
Phone
(505) 503-6800
NPI assigned
Nov 22, 2013
Last updated
Oct 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2023

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

Authorized official

Name
Anne Cannon
Title
Owner
Phone
(505) 503-6800

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X CNP-02033 NM
Mental Health Counselor 101YM0800X 0112181 NM
Marriage & Family Therapist 106H00000X 0084711 NM Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

4425 Juan Tabo Blvd NE Ste 112
Albuquerque, NM 87111-2684

Mailing address

4425 Juan Tabo Blvd NE Ste 112
Albuquerque, NM 87111-2684
Phone (505) 503-6800

Other practice location 1

9201 Montgomery Blvd NE Ste 301
Albuquerque, NM 87111-2467
Phone (505) 503-6800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140327000787 NM Part B Supplier - Clinic/Group Practice 0446481881 Receives reassigned benefits from 15 practitioners
Practice locations: Albuquerque, NM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2251366Elemental Health and Wellness Center LLC9201 Montgomery Blvd, BLDG 3, Ste 301, Albuquerque, NM 87111Certificate of waiverFeb 1, 2028

National Provider Directory

National Provider Directory

Locations

4425 Juan Tabo Blvd NE
Ste 112
Albuquerque, NM 87111
Phone (505) 503-6800

9201 Montgomery Blvd NE
Ste 301
Albuquerque, NM 87111
Phone (505) 717-1076

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1385078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1891125183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 JUAN TABO BLVD NE STE 112",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112684",
            "telephone_number": "505-503-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 JUAN TABO BLVD NE STE 112",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112684",
            "telephone_number": "505-503-6800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9201 Montgomery Blvd NE Ste 301",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871112467",
            "country_code": "US",
            "telephone_number": "505-503-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELEMENTAL HEALTH AND WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-22",
        "last_updated": "2023-10-13",
        "certification_date": "2023-10-13",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-503-6800"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "CNP-02033",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "0112181",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NM",
            "license": "0084711",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Oct 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.