MEDICARE: HOLISTIC MENTAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	C-09162	NM

General Provider Information

NPI Number	:	1609302454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 634
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-0634
Country	:	US
Telephone Number	:	575-680-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 E FLEMING AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3448
Country	:	US
Telephone Number	:	575-680-6450
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MRS. NANCY YADIRA TALAMANTES
Credential	:	LCSW
Telephone Number	:	575-680-6450

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	08/10/2017

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