Healthcare Provider Details

I. General information

NPI: 1376185488
Provider Name (Legal Business Name): TRIQUETRA THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19478 HIGHWAY 314
BELEN NM
87002-8223
US

IV. Provider business mailing address

1224 SILVA RD
BELEN NM
87002-7563
US

V. Phone/Fax

Practice location:
  • Phone: 505-357-4385
  • Fax: 505-212-0642
Mailing address:
  • Phone: 505-314-4966
  • Fax: 505-212-0642

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: DR. DENAI FORREST
Title or Position: PMHNP-BC
Credential: DNP, CNP, PMHNP-BC
Phone: 505-357-4385