Healthcare Provider Details

I. General information

NPI: 1205331121
Provider Name (Legal Business Name): NEW MEXICO PSYCHOLOGICAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ANTHONY DR
ANTHONY NM
88021-9366
US

IV. Provider business mailing address

224 ANTHONY DR
ANTHONY NM
88021-9366
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-2230
  • Fax:
Mailing address:
  • Phone: 575-520-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0057C
License Number StateNM

VIII. Authorized Official

Name: VICTOR TORRES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 575-520-2230