Provider Demographics
NPI:1871881326
Name:EATING DISORDERS TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:EATING DISORDERS TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FINLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, CEDS, CSP
Authorized Official - Phone:505-266-6121
Mailing Address - Street 1:5203 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2683
Mailing Address - Country:US
Mailing Address - Phone:505-266-6121
Mailing Address - Fax:505-271-1065
Practice Address - Street 1:5203 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 2-B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2683
Practice Address - Country:US
Practice Address - Phone:505-266-6121
Practice Address - Fax:505-271-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1291251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health