Healthcare Provider Details

I. General information

NPI: 1235473067
Provider Name (Legal Business Name): THERAPEUTIC SOLUTIONS OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SOUTH TERRACE AVENUE
CHAMA NM
87520
US

IV. Provider business mailing address

PO BOX 692
CHAMA NM
87520-0692
US

V. Phone/Fax

Practice location:
  • Phone: 575-209-0223
  • Fax:
Mailing address:
  • Phone: 575-209-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0144081
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNM0614
License Number StateNM

VIII. Authorized Official

Name: MELISSA TARAZON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-209-0223