Healthcare Provider Details

I. General information

NPI: 1376577221
Provider Name (Legal Business Name): FORENSIC BEHAVIORAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 MONTGOMERY PKWY NE WEST NE. SUITE 102
ALBUQUERQUE NM
87111-3852
US

IV. Provider business mailing address

10409 MONTGOMERY PARKWAY WEST NE SUITE 102
ALBUQUERQUE NM
87199-2002
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5499
  • Fax: 505-888-5498
Mailing address:
  • Phone: 505-888-5499
  • Fax: 505-888-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number08028036
License Number StateNM

VIII. Authorized Official

Name: DR. TROY J. RODGERS
Title or Position: AGENCY DIRECTOR
Credential: PSY.D. LPCC
Phone: 505-888-5499