Healthcare Provider Details

I. General information

NPI: 1013207356
Provider Name (Legal Business Name): META, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 CORRALES ROAD
CORRALES NM
87048
US

IV. Provider business mailing address

PO BOX 531
CORRALES NM
87048-0531
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-5662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number266
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number266
License Number StateNM

VIII. Authorized Official

Name: DR. WAYNE ROWAN MAES
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 505-898-5662