Healthcare Provider Details

I. General information

NPI: 1467319780
Provider Name (Legal Business Name): CENTRACARE WELLNESS & PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 ENCINO PL NE STE 6
ALBUQUERQUE NM
87102-2624
US

IV. Provider business mailing address

401 MISSION ARCH DR
ROSWELL NM
88201-6792
US

V. Phone/Fax

Practice location:
  • Phone: 210-214-3865
  • Fax:
Mailing address:
  • Phone: 210-214-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LYDIA CARTER
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 210-214-3865