Basic Information
| Provider Information | |||||||||
| NPI: | 1396237848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTELLIGENT HYPNOTHERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 LANG AVE NE STE 110 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057982552 | ||||||||
| FaxNumber: | 5057969601 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 LANG AVE NE STE 110 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057982552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEUGER | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5057982552 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.