Provider Demographics
NPI:1407730609
Name:THIRD WAVE PSYCHOTHERAPY OF NEW MEXICO
Entity type:Organization
Organization Name:THIRD WAVE PSYCHOTHERAPY OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-977-7972
Mailing Address - Street 1:10400 ACADEMY RD NE STE 345
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7351
Mailing Address - Country:US
Mailing Address - Phone:505-345-6100
Mailing Address - Fax:505-212-0042
Practice Address - Street 1:10400 ACADEMY RD NE STE 345
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7351
Practice Address - Country:US
Practice Address - Phone:505-345-6100
Practice Address - Fax:505-212-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health