Healthcare Provider Details

I. General information

NPI: 1760102313
Provider Name (Legal Business Name): FAITH MENTAL HEALTH AND WELLNESS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 LOUISIANA BLVD NE
ALBUQUERQUE NM
87113-1738
US

IV. Provider business mailing address

204 144TH LN NW
ANDOVER MN
55304-6277
US

V. Phone/Fax

Practice location:
  • Phone: 806-535-3104
  • Fax:
Mailing address:
  • Phone: 806-535-3104
  • 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: ERIN BAYLES
Title or Position: CREDENTIALING ADMIN
Credential:
Phone: 478-290-3122