Healthcare Provider Details

I. General information

NPI: 1376086744
Provider Name (Legal Business Name): CHILD PSYCHOLOGICAL SERVICES OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1825
US

IV. Provider business mailing address

2811 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87106-1825
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-3029
  • Fax:
Mailing address:
  • Phone: 505-250-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0940
License Number StateNM

VIII. Authorized Official

Name: AMBER L HAYES
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 505-250-3029