Healthcare Provider Details

I. General information

NPI: 1821370842
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSESSMENT & TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 CORRALES RD
CORRALES NM
87048-8663
US

IV. Provider business mailing address

4313 CORRALES RD
CORRALES NM
87048-8663
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-3595
  • Fax: 855-690-6884
Mailing address:
  • Phone: 505-440-3595
  • Fax: 855-690-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number757
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number757
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number333
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number333
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number757
License Number StateNM
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number333
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number333
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number757
License Number StateNM
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number757
License Number StateNM

VIII. Authorized Official

Name: DR. LAURA LOUISE SMITH
Title or Position: MANAGING MEMBER
Credential: PH.D.
Phone: 505-440-3595