Healthcare Provider Details

I. General information

NPI: 1285088658
Provider Name (Legal Business Name): EPOCH BEHAVIORAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2796
US

IV. Provider business mailing address

250 S MAIN ST
LAS CRUCES NM
88001-1278
US

V. Phone/Fax

Practice location:
  • Phone: 575-525-8484
  • Fax: 575-449-2445
Mailing address:
  • Phone: 575-525-8484
  • Fax: 575-449-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name: EDDIE ALVAREZ
Title or Position: CREDENTIALING SPECIALIST
Credential: NRCMA
Phone: 575-449-2718