Healthcare Provider Details

I. General information

NPI: 1013617240
Provider Name (Legal Business Name): SENIOR PSYCHOLOGICAL CARE OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 W GILCHRIST AVE
ARTESIA NM
88210-1134
US

IV. Provider business mailing address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax:
Mailing address:
  • Phone: 713-850-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RANDALL J FRAPART
Title or Position: CFO
Credential:
Phone: 713-850-0049