Organization · NPI-2

505 Diagnostics LLC

Psychologist, Clinical · Albuquerque, NM

NPI number1629810486
StatusActive
Last updated in NPPESFeb 4, 2025

Details

NPI
1629810486
Entity type
Organization (NPI-2)
Legal business name
505 Diagnostics LLC
Organization subpart
No
Enumeration date
Jun 11, 2024
Certification date
Feb 4, 2025
Last updated
Feb 4, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103TC0700X Psychologist, Clinical––Yes
101YP2500X Counselor, Professional––

Practice location

4225 Montgomery Blvd Ne
Albuquerque, NM 87109-1103

Phone 505-361-1931 · Fax 505-521-5147

Mailing address

4225 Montgomery Blvd Ne
Albuquerque, NM 87109-1103

Phone 505-548-8035 · Fax 505-581-3291

Authorized official

Rebekah Jan Hutchins Khan
Ceo/Provider
4707289352

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Psychologist, Clinical providers in Albuquerque, NM