Healthcare Provider Details

I. General information

NPI: 1457119489
Provider Name (Legal Business Name): STABILITY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MENAUL BLVD NE
ALBUQUERQUE NM
87110-3379
US

IV. Provider business mailing address

182 PRAIRIE WIND DR
WENTZVILLE MO
63385-2747
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-8483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JELYA FATAWU
Title or Position: PMHNP-BC
Credential: APRN
Phone: 216-246-5697