Healthcare Provider Details

I. General information

NPI: 1023101094
Provider Name (Legal Business Name): ALBUQUERQUE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 MOUNTAIN RD NE STE 200B
ALBUQUERQUE NM
87110-7833
US

IV. Provider business mailing address

PO BOX 13387
ALBUQUERQUE NM
87192-3387
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-6500
  • Fax: 505-830-6527
Mailing address:
  • Phone: 505-830-6500
  • Fax: 505-830-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LESTER J. BRASHER JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD. LPCC
Phone: 505-830-6500