Healthcare Provider Details

I. General information

NPI: 1851207609
Provider Name (Legal Business Name): AVALON PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GOLD AVE SW # 207
ALBUQUERQUE NM
87102-3335
US

IV. Provider business mailing address

8206 LOUISIANA BLVD NE STE A
ALBUQUERQUE NM
87113-1738
US

V. Phone/Fax

Practice location:
  • Phone: 817-899-8856
  • Fax:
Mailing address:
  • Phone: 817-899-8856
  • 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: VICTORIA AGUDAH
Title or Position: OWNER
Credential:
Phone: 817-899-8856