Organization Active NPI

Anchored Therapy LLC

  • Clinical Psychologist
  • Albuquerque, NM
National Provider Identifier
1992562995
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
ANCHORED THERAPY LLC
Practice address
2601 Wyoming Blvd NE Ste 116
Albuquerque, NM 87112-1000
Phone
(505) 633-0643
NPI assigned
Mar 5, 2024
Last updated
Oct 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Fernando Ortiz
Title
Credentialing Manager
Phone
(575) 707-8150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

2601 Wyoming Blvd NE Ste 116
Albuquerque, NM 87112-1000

Mailing address

8226 Menaul Blvd NE # 623
Albuquerque, NM 87110-4614

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241231003667 NM Part B Supplier - Clinic/Group Practice 4688101777 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM

National Provider Directory

National Provider Directory

Locations

2601 Wyoming Blvd NE
Ste 116
Albuquerque, NM 87112
Phone (505) 633-0643

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1992562995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8226 MENAUL BLVD NE # 623",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871104614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 WYOMING BLVD NE STE 116",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871121000",
            "telephone_number": "505-633-0643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCHORED THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "ORTIZ",
        "authorized_official_first_name": "FERNANDO",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "575-707-8150"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "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 Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.