Healthcare Provider Details

I. General information

NPI: 1194673772
Provider Name (Legal Business Name): MESA PATH BEHAVIORAL AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 MANZANO ST NE
ALBUQUERQUE NM
87110-6302
US

IV. Provider business mailing address

618 MANZANO ST NE
ALBUQUERQUE NM
87110-6302
US

V. Phone/Fax

Practice location:
  • Phone: 602-706-2380
  • Fax:
Mailing address:
  • Phone: 602-706-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MATTIE GAFFNEY
Title or Position: CEO
Credential:
Phone: 602-706-2380